Inspection on 19/11/08 for The Lindens

This inspection was carried out on 19th November 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Lindens 20/06/08

The Lindens 25/06/07

The Lindens 31/01/07

The Lindens 01/08/06

The Lindens 10/11/05

The Lindens 19/04/05

The Lindens 24/09/04

The Lindens 04/05/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 31/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Lindens The Lindens Stoke Hammond Buckinghamshire MK17 9BH     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Chris Schwarz     Date: 1 9 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: The Lindens The Lindens Stoke Hammond Buckinghamshire MK17 9BH 01908371705 01908375075 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Michael Hannelly care home 17 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 17. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Dementia (DE). Date of last inspection Brief description of the care home The Lindens is a privately owned care home and is registered to provide residential and personal care for up to 17 older people. The home is situated in a rural area on the outskirts of the village of Stoke Hammond and is within easy distance of Bletchley and Milton Keynes. The home is a large detached Edwardian house set in accessible, extensive grounds. The house has been subject to a programme of refurbishment to comply with the current standards. All rooms are single and have en suite shower and toilets. Additional assisted bathrooms and toilets are provided. There are two goodsized social areas for service users on the ground floor. Care Homes for Older People Page 4 of 31 Over 65 0 17 17 0 Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced key inspection was conducted over the course of a day by Chris Schwarz and covered all of the key National Minimum Standards for older people. The last key inspection of the service took place on 20th June 2008. Prior to the visit, a detailed self-assessment questionnaire was sent to the home for completion and comment cards were sent to a selection of people living at the home, staff and visiting professionals. Any replies that were received have helped to form judgements about the service. Information received by the Commission since the last inspection was also taken into account. The inspection consisted of discussion with the joint owner, manager and other staff, opportunities to meet with people using the service, examination of some of the Care Homes for Older People Page 6 of 31 homes required records, observation of practice and a tour of the premises. A key theme of the visit was how effectively the service meets needs arising from equality and diversity. Feedback on the inspection findings and areas needing improvement was given to the manager and joint owner at the end of the inspection. The joint owner, manager, staff and people who use the service are thanked for their co-operation and hospitality during this unannounced visit. What the care home does well: What has improved since the last inspection? What they could do better: Medication practice needs to be improved by staff signing the medication administration records where they handwrite a medication and its instructions for use, with a second person signing to verify the details have been checked and are correct. This is to make sure that details are accurate and in accordance with the prescribers instructions. Written protocols need to be in place for any as required medication in use at the home, to ensure that its use is consistent. Accurate and full instructions need to be in place for any hand written entries on medication administration records to make sure that medicines are administered in line with the prescribers instructions. Care Homes for Older People Page 8 of 31 Care plan files could be improved through removal of out of date information to ensure that staff can easily ascertain peoples care needs. All documents within care plan files need to be dated and signed by staff so that it is clear who produced them and when. The home needs to produce its own care plans on the management of any further serious infections, rather than rely upon district nursing plans which direct nursing care only, to make sure that needs are met and that infection is contained. The complaints and safeguarding procedures require amendment to be effective in listening to and reducing the risk of harm to people using the service. Basic information, such as who regulates the home and the contact details need to be accurate. Risk assessments need to be put in place for the use of portable electric heaters in bedrooms, to make sure that people using the service are not placed at risk of harm. Staff practice could be improved by ensuring that the full range of mandatory courses is undertaken by all staff, plus dementia awareness, to make sure that carers have the necessary skills and competencies to meet needs. This should include training in infection control. The rotas at the home need to reflect who the on call person is each night in order that they and waking night staff know who can be called on for assistance. The provider needs to ensure that changes to management of the home are notified to the Commission for Social Care Inspection promptly to comply with regulatory responsibilities. Health and safety could be improved through ensuring that accident records and daily notes make clear when accidents have occurred, the injuries sustained and outcomes to make sure that important information is consistently recorded. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are assessed prior to admission and are given opportunity to visit the home beforehand to ensure it meets their needs. Evidence: The home had a statement of purpose in place which had been updated since the last key inspection. It provided a good range of information about The Lindens and would be useful in assisting people and their relatives to make a decision about moving in. It had been produced in a large font to make it easier to read. There had not been any new admissions of permanent users to the home. One respite care admission had taken place and documents were available to show that the persons care needs had been assessed prior to coming in. This covered areas of need such as mobility, hearing, communication, dressing, washing, bathing and continence and had been signed by the person undertaking the assessment. There was no date on Care Homes for Older People Page 11 of 31 Evidence: the assessment though. A generalised recommendation to make sure that all documents are signed and dated is made later on in the report. Information about the persons personal circumstances and next of kin had been noted and their was information provided by the persons doctor about their medical history. Staff had issued a receipt to verify that money had been deposited for safekeeping whilst the person was staying at the home. A contract had been put in place relating to the period of respite care and made clear the fees for the placement. The contact details of the Commission for Social Care Inspection had been added to the contract in order that the person and/or their family were aware of who the regulator is and how to contact us. Information on the current range of fees for permanent or respite care placements may be obtained by contacting the home directly. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care needs of people living at the home are being met, promoting health and well-being and taking into account their preferences and individual requirements. Medication practice needs attention to ensure it is handled in a safe and consistent manner. Evidence: Eight people were living at the home at the time of this visit. All were met during the course of the day. People had been assisted to look smart and clean and there was good regard for their dignity. Staff interactions conveyed dignity and respect at all times. All personal care was carried out in private areas of the home. Call bells were observed to be answered promptly. Care plans were in place for people living at the home; two were read in detail. Both care plans consisted of documents across two to three files with a mixture of a purchased care planning format book and documents produced by the home. There was duplication of some information between the two records. Files contained some Care Homes for Older People Page 13 of 31 Evidence: out of date information which made it difficult to locate current needs such as a risk assessment produced in 2004 which said that the user walks slowly with a frame although later assessments in the folder confirm that the person had been a wheelchair user for two years, a quality assurance tick list last used in March 2007 and a residents care plan update form from 2006 which had been replaced by a later edition. During feedback to the manager and joint owner it was advised that information which is no longer relevant is added to an archive file to reduce clutter in files and to make sure that staff can easily see what peoples care needs are. A recommendation is made to address this. The main care plan document provided by the home identifies areas of need such as personal care and physical well-being and nutrition and dietary preferences with each area of need sub divided into what staff need to do for me and outcomes. There is then space to make any amendments or changes as peoples needs alter. On one of the two care plan files this format had been particularly well presented with cross referencing to risk assessments and other documents and would be of good use to staff as information was clear and up to date. In the other file information was still at a hand written stage and did not contain the cross referencing. Some documents such as a pool activity level assessment and a personal risk assessment had not been signed by the person completing them therefore the relevance to current needs was not known. A dietary risk assessment and a mobility risk assessment had reviewing dates just of 2008 written on them where new details had been added. A recommendation is made to make sure that all documents at the home are dated and signed by staff. Risk assessments covered areas such as peoples mobility, dietary needs, skin care and care. One persons care risk assessment identified that in December (no year given) the person was needing barrier nursing due to Clostridium difficile infection. The manager and joint owner were asked if a specific care plan had been drawn up at that time to address this important area of need. They said the home had relied on the district nurse to oversee care. Whilst a nursing plan produced by the district nurse would have been crucial to the persons care, it would have directed nursing input. The home needs to produce its own guidance to staff to direct care practice, as with all other areas of peoples needs. Should this or any other serious infections be present at the home in the future, a specific care plan ought to be produced by the home to direct staff on care practice. The formatted care plan books had been kept up to date and provided useful information about care needs in both cases. Photographs of users had been included. Health care contacts were noted on the inside cover for quick reference and personal Care Homes for Older People Page 14 of 31 Evidence: information was noted. Information included a brief personal profile, last wishes, social and leisure details, physical health, mental health assessments, moving and handling assessments, behaviour assessments, risk of developing pressure damage, nutritional screening and risk of falls. Information had been reviewed on a regular basis. Records of peoples weights and appointments or visits by health care professionals were contained in a separate file. There was evidence that people are being weighed regularly and have access to, for example, district nurses, doctors and dieticians as necessary. Medication was being managed using a monitored dose system. The medication trolley was secure and kept locked when not in use. There was also a lockable medicines fridge. The member of staff was observed administering morning medication correctly, securing the trolley after preparing each persons medicines, taken them in a pot to the user with a drink and waiting for them to be taken before returning to the office to sign the records and prepare the next persons medicines. The medication administration records currently is use were looked at and some concerns brought to the attention of staff, the manager and joint owner. Where staff had hand written medicines onto the record sheets supplied by the pharmacy, they were not consistently signing the entry and getting a second person to sign to verify instructions were correct. This included trifluoperazine and promazine hydrochloride. In addition, the dose times had not been included for the promazine. The instruction just said 5ml or 10ml. It was also noted that the trifluoperazine (a sedative) was prescribed as required. There was no protocol written by management to stipulate under what circumstances it is to be given and measures to be taken before considering use of the medicine. Requirements are made to address each of these shortfalls. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Activities are available to people using the service to provide them with stimulation and contact with family, friends and the community is supported to maintain social links. Food is well prepared and presented attractively to make sure that nutritional needs are met and respecting peoples preferences. Evidence: An activities folder was being maintained to note what events had taken place. This included puzzles, crafts, games, bingo, gentle movements, dominoes, and reading the newspaper. A music man visits every fortnight which people using the service enjoy and a PAT dog visited during the inspection. A hairdresser visits once a week, garden chairs and a table are available in the grounds for people to enjoy fine weather and visitors were seen to be free to see users and were made welcome by staff. A board in the dining room showed pictures of a 100th birthday celebration for one of the service users. The dining room was attractively arranged with several small dining tables set with table cloths, linen napkins and floral arrangements. People using the service were served a lunch of tomato soup, beef stew with carrots, green beans and mashed Care Homes for Older People Page 16 of 31 Evidence: potato and jam roly poly and custard. Several said lunch was lovely, that the meat was tender and that they enjoyed the home made pudding. Food had been presented attractively and courses served when people were ready. Those who wanted it enjoyed a glass of wine with the meal. A three week menu was in use at The Lindens. The chef has achieved National Vocational Qualification level 2 in catering and takes responsibility for ordering supplies. She works five days a week and there is an assistant chef working the remaining days. The kitchen was well stocked and there was plenty of fresh fruit available. No special diets were necessary for the current user group; one person needs a liquidised diet which was being done. People using the service can choose where to have breakfast - some like to have it in their room whilst others may opt to come into the dining room. Afternoon tea was served in the lounge. Care Homes for Older People Page 17 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints and safeguarding (adult protection) procedures need to be revised to make sure that they are effective in listening to and reducing the risk of harm to people using the service. Evidence: In information supplied in the pre-inspection self-assessment, the joint owner said there had not been any complaints or safeguarding referrals and confirmed that this was still the case. A complaints log book was in place in the event of any complaints the last entry was several years ago. Complaints procedures at the home, other than in the revised statement of purpose, had old contact details for the Commission for Social Care Inspection. Information within the staff handbook about making complaints also contained out of date contact details and referred to the regulator being the County Council. Both of these documents will need to be revised and any other copies of the complaints procedure in other documents will need revising also. A requirement is made to address this to make sure that people have accurate details of the regulator and how to contact them. It would be good practice to send all relatives a revised complaints procedure when this has been done and to display a copy within the home in a visible place. The homes safeguarding procedure encourages investigation to take place if evidence is found that abuse has occurred. The necessity to inform the Social Services Care Homes for Older People Page 18 of 31 Evidence: Department urgently and take advice, and the Commission for Social Care Inspection within 24 hours, if there are allegations or suspicions of abused was not spelled out. The policy needs to be re-written to make sure that staff act in accordance with these requirements and additionally to ensure that they do not prejudice any potential criminal proceedings by the type of questioning and investigation they could be encouraged to follow under the current policy. A requirement is made to address this. These deficits in procedures were brought to the joint owners attention during inspection of her other registered service in July this year. The home also needs to obtain a copy of the local authority inter agency safeguarding guidelines. Staff training records did not show that all carers have received training in safeguarding. Care Homes for Older People Page 19 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The building is clean and homely and promotes a positive environment for the people who live there. Evidence: The home is located in Stoke Hammond which is just outside of Bletchley and Milton Keynes. The building is a large detached property by a canal with views across open countryside. Accommodation is on three floors with stair lift access to all levels. On the ground floor there is a large lounge and separate dining room, the kitchen and laundry area and office. Bedrooms are on each of the three floors, all are single occupancy and have en suite shower and toilet facilities. Bedrooms that were looked at were clean, personalised to different degrees and homely. Portable electric heaters had been added to some of the bedrooms; there were no risk assessments on the use of these and a requirement is made to address this to ensure that people using the service are not placed at risk of injury. The kitchen and laundry areas were clean and tidy and there were no unpleasant odours around the building. The washing machine had two sluice programmes. Cleaning products were being kept safely. Since the last inspection, it was possible to see that potential hazards around the building are checked for during both the providers monitoring visits and in two visual hazard checks of the premises. Care Homes for Older People Page 20 of 31 Care Homes for Older People Page 21 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides sufficient staff to meet current care needs and carers are respectful and attentive to people using the service. Records within the home do not reflect that the staff team has the necessary mandatory and specialist training to meet peoples needs. Evidence: There had not been any new staff join or leave the staff team since the last key inspection and no agency workers were being used. On arrival at the home, two carers, one a senior, were on duty with eight service users plus the chef and a domestic worker. Rotas reflected that there have usually been three staff working in the mornings, two covering afternoon and evening shifts and one waking night staff. The joint owner and manager said that two carers live on the premises and take it in turns to be on call and available to waking night staff as required. It is recommended that the rota reflects who the on call person is for each day so that that member of staff, and night carers, are formally aware of this. Four requirements were made at the last inspection regarding staffing practice. One regarding the ratio of care staff to service users was being met. Two related to the recruitment of new staff and could be tested out for compliance as no new staff have started. These requirements will need to be borne in mind by the manager and Care Homes for Older People Page 22 of 31 Evidence: provider should new staff be considered to work at the home in the future. It was possible to see that procedures have been put in place to address these shortfalls though. A policy document had been written to make sure that any new staff commencing on preliminary POVAfirst clearance are supervised until full Criminal Records Bureau clearance is received. A checklist was also seen ready to be used to make sure that all of the required recruitment checks are obtained. One of the requirements made at the last inspection related to suitably qualified, competent and experienced staff working at the home. This had not been wholly met. Training records of five staff were looked at. In file 1 there was evidence of moving and handling and fire safety training only. In file 2 there was only evidence of moving and handling training and safe administration of medicines. In file 3 there was evidence of safeguarding, moving and handling and oral health training. In file 4 there was evidence of fire safety, oral health and moving and handling training. In file 5 there was better evidence including oral health training, moving and handling, medicines awareness, food handling and hygiene, first aid, fire safety, National Vocational Qualification level 2, and an open learning level 2 certificate in safe handling of medication. Out of all the files looked at, not one contained the full range of mandatory courses. It would also be expected that staff undertake dementia awareness (as the home is registered to provide care to people in this category) plus infection control as a standard good practice. A requirement is made to address training deficiencies. Staff that were met during the course of the day were respectful to people using the service and did not rush them. There was good regard for peoples privacy and dignity and staff were attentive when users needed assistance. All staff who assisted with the inspection were polite and friendly. Care Homes for Older People Page 23 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Health and safety is being effectively managed at the home and there is regular monitoring of the home to make sure peoples needs are addressed. A change of manager has taken place which needs to be confirmed in writing. Evidence: There had been a recent change of manager at The Lindens. On arrival at the home, staff were uncertain who was actually managing the home and directed questions toward the joint owner when she arrived. She confirmed that a change of manager had occurred and that a previous manager was being reinstated and would be applying for registration. The joint owner was reminded of the need to confirm in writing promptly any changes to management of the home and a requirement is made to address this. A requirement to undertake monthly monitoring visits to the home to assess quality of care, was being complied with. Reports of these visits showed that these are taking place and include speaking with staff and people using the service and commenting on Care Homes for Older People Page 24 of 31 Evidence: the condition and cleanliness of the premises. Other auditing tools were seen in use at the home such as a care plan audit, accident audit and medication audit. Management of service users money was checked. There were individual transaction records, receipts to verify expenditure and separate money bags for each person. A check of two peoples money and records showed that one tallied, the other was over by a pound. The manager and joint owner were advised to check over the record sheets to see if the pound related to a calculation error and to amend the records once located. Various health and safety checks were being undertaken at the home. There was a health and safety policy in place. Hoists had been serviced in October this year and Legionella testing had taken place in February this year with satisfactory results. Portable electrical appliances had been checked in 2008 and there was a certificate of satisfactory electrical hard wiring. The home does not have a gas supply. The stair lift had been serviced in September this year. A notice had been added to one persons bedroom door to alert that oxygen was being stored in there. The joint owner and manager were advised to make sure the fire based risk assessment also reflected the location of oxygen cylinders and this was attended to during the inspection. Records of accidents were being maintained and an audit tool was being used to look at trends. One person was case tracked across three incidents identified on the audit tool, from different months. An accident form had been completed in each case. For one accident which resulted in the user needing to be checked over in hospital, the outcome of going to hospital was not noted on the form - such as whether there was any or no injury etc. Cross referencing with daily notes, the accident and outcome was not mentioned, it just said (name of person) came back from hospital at 4.30 pm, had a good tea tonight - no problems. It is recommended that accident records and daily notes provide more information about injuries and outcomes, especially where people attend hospital. An environmental health inspection of the kitchen in December 2007 resulted in action to make sure freezers in the room adjacent to the kitchen are not used to store laundered items on. This was being complied with. When looking at staff training records there were gaps to food handling, first aid and moving and handling training and a requirement has been made under the section looking at staffing issues. It is also recommended that staff attend training in infection control as a standard good practice in care homes. Care Homes for Older People Page 25 of 31 Care Homes for Older People Page 26 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 13 A protocol is be written for any as required medication in use at the home. This is to ensure that its use is consistent. 19/12/2008 2 13 Staff are to sign the medication administration records where they handwrite a medication and its instructions for use, with a second person signing to verify the details have been checked and are correct. This is to make sure that details are accurate and in accordance with the prescribers instructions. 19/12/2008 3 13 Accurate and full instructions are to be in place for any hand written entries on medication administration records. 19/12/2008 Care Homes for Older People Page 28 of 31 This is to make sure that medicines are administered in line with the prescribers instructions. 4 16 22 The complaints procedure is to be revised to state the correct regulatory body and the contact details of the regional office in Maidstone, Kent. This is to ensure that people are provided with correct information. 5 18 13 The safeguarding (adult protection) procedure is to be revised. This is to makes clear a duty to refer promptly to the Social Services Department any allegation or suspicion of abuse and to notify the Commission for Social Care Inspection within 24 hours of any allegation or suspicion of abuse. 6 19 13 Risk assessments are to be put in place for the use of portable electric heaters in bedrooms. This is to ensure that people using the service are not placed at risk of harm. 7 30 18 The full range of mandatory courses is to be undertaken by all staff, plus dementia awareness. 01/03/2009 19/12/2008 01/01/2009 19/12/2008 Care Homes for Older People Page 29 of 31 This is to make sure that carers have the necessary skills and competencies to meet needs. 8 31 8 Changes to management of 19/12/2008 the home are to be notified to the Commission for Social Care Inspection promptly This is to comply with regulatory responsibilities. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 The home is to produce its own care plans on the management of any further serious infections to make sure that needs are met and that infection is contained. All documents at the home are to be dated and signed by staff so that it is clear who produced them and when. Out of date information in care plan files is to be archived to ensure that staff can easily ascertain peoples care needs. Relatives are to be sent a copy of the revised complaints procedure which shows clearly who the regulator is and contact details. A copy of the revised procedure is to be displayed visibly at the home for other people to see. A copy of the local authority inter agency safeguarding guidelines is to be obtained to refer to. The rotas are to reflect who the on call person is each night in order that they and waking night staff know who can be called on for assistance. Accident records and daily notes are to make clear when accidents have occurred, injuries sustained and outcomes to make sure that important information is consistently recorded. Staff training should include infection control as a standard good practice in making sure that risks from contamination are eliminated. 2 3 7 7 4 16 5 6 18 27 7 38 8 38 Care Homes for Older People Page 30 of 31 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). 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