Inspection on 31/01/07 for The Lindens

This inspection was carried out on 31st January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 Lindens 19/11/08

The Lindens 20/06/08

The Lindens 25/06/07

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE The Lindens Stoke Hammond Bucks MK17 9BH Lead Inspector Jane Handscombe Unannounced Inspection 31st January 2007 11:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000028059.V329396.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. DS0000028059.V329396.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Lindens Address Stoke Hammond Bucks MK17 9BH 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) 01908 371705 01908 375075 N/A Mr Michael Hannelly Linda Rose Howell Care Home 17 Category(ies) of Dementia - over 65 years of age (5), Old age, registration, with number not falling within any other category (17) of places DS0000028059.V329396.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for up to 17 service users, up to five of whom may have dementia. 1st August 2006 Date of last inspection Brief Description of the Service: 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 good-sized social areas for service users on the ground floor. There is a team of carers who provide support to residents during the day and two staff awake at night to assist residents who may need help. Fees range from £386 to £600 per week. DS0000028059.V329396.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This inspection of the service was an unannounced ‘Key Inspection’ which was undertaken on 31st January 2007. The inspection involved one inspector, which took place over eight hours. It was a thorough look at how well the service is doing. It took into account detailed information provided by the registered provider, and any information that CSCI has received about the service since the last inspection. The inspector asked the views of the people who use the services, staff members and other people seen during the inspection or who responded to questionnaires that the Commission had sent out. The inspector looked at how well the service was meeting the standards set by the government and has in this report made judgements about the standard of the service. Comments received from residents and visitors/family members during the inspection process included: ‘Their hearts are where they should be, just feel there could be more interaction from staff’ ‘I think the meals are excellent’ ‘Staff always very helpful, I think they are well trained, they know their job’ ‘lacking one to one attention’ you feel you belong here, not just with staff but other residents too’ ‘Baths have been reduced from alternate days; now it is about once a week’ ‘activities far and few between - always enjoy people coming in eg music etc, but this doesn’t happen other than once a month. It would be nice if the home had an activities person, the staff have not got the time’. Comments received from staff include: We are ‘team players all of us’ ‘this is one of the best homes I’ve worked in…the care is outstanding’ ‘the manager and her deputy are very approachable’ DS0000028059.V329396.R01.S.doc Version 5.2 Page 6 The inspector would like to thank the residents, their families, staff members and other health professionals for their time and assistance during this inspection What the service does well: What has improved since the last inspection? Following the previous inspection there has been some progress made in relation to redecoration and addressing some of the issues highlighted during the last inspection. The proprietor has repaired the roof, which was seen to have caused water damage to a number of service users’ rooms, evidenced during the last inspection. Work has been in progress to remove the combustible materials in the cellar which houses the homes boiler although there is still a few items remaining to be removed. The boiler has since the last inspection, been serviced and the legionella assessment has been undertaken. Whilst this assessment is required to be undertaken annually, the proprietor has taken steps to ensure this is undertaken on a six monthly basis, which is seen as very good practice. DS0000028059.V329396.R01.S.doc Version 5.2 Page 7 Protection of Vulnerable Adults and Food Hygiene training has been delivered to staff. A further Food Hygiene training has been arranged, later this month, to ensure all staff are trained and updated. The registered manager and deputy manager have both undertaken and gained their Registered Managers Awards. The showerheads within the home have all now been de-scaled and documented and a programme is in place to ensure this continues. New vinalay flooring has been laid in the kitchen area at the top of the home and one bedroom has had a new carpet laid. A further bedroom has had vinalay laid outside the en-suite to avoid wetting the carpet as was the case during the last inspection. What they could do better: There are a number of areas which the home could improve upon to ensure the health, safety and welfare of their clients, for which requirements and recommendations have been made. Ensure that requirements, when made, are addressed within the stated time. Ensure that all service users have a detailed plan of care within 48 hours of admission in order that care staff have clear details and instructions. Lack of care plans could compromise the service users needs not being met appropriately. Assessment of service users social needs must be included within the assessment to ensure they are being offered and met accordingly. Gain signatures to evidence that service users and/or their representatives have been consulted with and included in the assessment and care planning process. The recording of the administration of medication must be recorded appropriately to ensure that medication has in fact been given as prescribed. The registered manager must undertake regular medication audits to ensure that the recording of medication administration is adhered to appropriately. The registered manager musty provide regular activities suited to the residents’ needs and capabilities, to address their social needs and provide them with stimulation and variety. All instances of any written or verbal complaints/concerns must be logged appropriately, with details of the actions taken and the resulting outcomes. DS0000028059.V329396.R01.S.doc Version 5.2 Page 8 Where there are instances of gaps in staff members employment history, these must be pursued and recorded in the staff members personnel file, ensuring a robust recruitment is undertaken. To ensure the health, safety and welfare of the service users and staff, the proprietor must remove the remaining combustible materials and objects from the cellar, which houses the boiler. All maintenance issues, identified within this report for improvement or attention, must be attended to ensuring those who use the service are provided with a safe, well maintained home with comfortable bedrooms in which to live. In instances in which service users have challenging behaviour, the registered manager must ensure to review the assessments of needs regularly to ensure that the home has the necessary skills and resources to meet the needs of the service user appropriately. A systematic quality assurance programme, based on seeking the views of service users, family members, health professionals and any others who come into contact with the home, must be implemented in order to gain feedback on the quality of the services provided enabling the registered manager to measure success in meeting the homes aims, objectives and statement of purpose. Further recommendations include a review of the care planning process to ensure a more detailed plan of action is included. It is a good practice recommendation to assess all residents’ nutritional status on admission using a nationally recognised tool. In instances where references for prospective members of staff are received without a company stamp or with compliments slip, it is good practice to verbally verify their authentication and document the verification accordingly. It is recommended that when the proprietor undertakes monthly monitoring views, these be more detailed to ensure that sufficient details are gathered in relation to the service and the services the home offers. 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. DS0000028059.V329396.R01.S.doc Version 5.2 Page 9 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 DS0000028059.V329396.R01.S.doc Version 5.2 Page 10 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): 3 and 5 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. All prospective service users undergo an assessment of needs and have an opportunity to visit and assess the facilities and suitability prior to being offered a place at Castle View. The assessments undertaken do not always evidence that service users and or their representatives have been involved in the process. Likewise assessments do not always evidence they have been undertaken by a person qualified to undertake such a task. EVIDENCE: The registered manager or her deputy carries out all pre admission assessments. The inspector was informed that the assessment is undertaken in collaboration with the individual and/or their representative, however of the three files viewed, one failed to contain the service users’/their representatives signature to evidence their involvement in the assessment and care planning process, whilst another failed to contain the signature of the person who DS0000028059.V329396.R01.S.doc Version 5.2 Page 11 undertook the assessment, both of which requirements have been made to address these issues. A sample of assessments were examined and found to form the basis of the development of the care plan, although one service users file failed to contain a care plan.(see section headed health and personal care) Wherever possible, prospective residents, family and friends are given the opportunity to visit the home and join fellow residents, in order to gain a ‘feel’ of the home and meet staff before making a decision as to whether the home is suitable. From the evidence seen by the inspector and comments received, the inspector considers that this service is able to provide a service to meet the needs of individuals of various religious, racial or cultural needs. DS0000028059.V329396.R01.S.doc Version 5.2 Page 12 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 adequate. This judgement has been made using available evidence including a visit to this service. Service users health, personal and social care needs are not always set out in an individualised plan of care. One service user did not have a care plan in place and, as a consequence, could be at risk of having their care needs undetected or at risk of not having them met. Policies and procedures are in place to protect service users who wish to maintain responsibility for their own medication. The recording of medication administration is poor. EVIDENCE: A sample of three service users care plans were viewed during the inspection. Of the three service users’ files, one failed to contain an individual care plan drawn up by the home highlighting how staff were to attend to the service users health, social and personal needs, any risks that may be present etc. DS0000028059.V329396.R01.S.doc Version 5.2 Page 13 consequently the service user could be at risk of having their care needs undetected and therefore at risk of not having them met. This particular service user had been admitted to the home some 13 days prior to the inspection. An immediate requirement was made to ensure that a care plan and any risks associated with these needs was to be drawn up and a copy sent to the Commission the following day. Evidence of these requirements being undertaken and put into place were received by the commission within the timescale however they were lacking some detail. The registered manager must ensure that all service users have a full plan of care drawn up within 48 hours of entering the home to ensure that staff are aware of the needs, how these needs are to be addressed and to ensure that the residents health, social and physical needs are met appropriately thereby ensuring their health, safety and welfare. Of the two further service users files viewed, care plans were lacking in some detail, although staff spoken to during the inspection demonstrated their awareness of service users needs and the care to be given. Evidence in both of the files highlighted that their hobbies, interests, likes and dislikes had not been assessed, thereby making it difficult to ascertain if the home was meeting their social needs. One of these files clearly noted an objective ‘ to ensure continues with activities he/she enjoys’, yet there was no written evidence to ascertain what the service users hobbies, interests, likes and dislikes are to ensure that this objective be met. Pressure sore risk assessment paperwork were found within the service users files but not always filled in and scores on other assessments, determining levels of risk, were not added up thereby rendering them meaningless. Of the care plans viewed, there was no evidence that residents nutritional status had been assessed on admission, using a recognised assessment tool: the Malnutrition Universal Screening Tool (MUST) is recommended. Whilst service users health needs are being met, it is recommended that the registered manager review the Care planning processes to ensure a more detailed plan of action is included. Likewise risk assessments detailing the level of risk, to whom, and a detailed action plan put in place. All service users are registered with GP’s and evidence was available to highlight that GP’s, District Nurses and other professionals were accessed when required. Records of health care appointments are recorded including those of the chiropodist who visits the home regularly. As part of case tracking service users, the inspector viewed the medication administration records and found evidence of poor recording taking place. Gaps in records failed to contain any coding system as to why the medication had not been administered, therefore making it impossible to ascertain if the medication had in fact been given. A requirement has been made to ensure DS0000028059.V329396.R01.S.doc Version 5.2 Page 14 any gaps in the recording of medication administration are documented appropriately and undertake regular medication audits, to reduce these types of errors. All medications were found to be stored appropriately, in a locked and secure cabinet. Access to the medication cabinet is by persons who have been designated to undertake medication administration only. The deputy manager explained that individual protocols have been put in place for medicines that are administered ‘’as required’’. Service users who wish to maintain responsibility for their own medication, are enabled to do so, wherever possible, within a risk management process. Discussions with care staff evidenced that they were knowledgeable on privacy and dignity issues and this was generally evident throughout the inspection. Staff were observed to respect the residents’ right to privacy, dignity and independence and were seen to knock on residents bedroom doors and bathrooms before entering whilst addressing residents by their preferred names. Service users receive care from staff and health care professionals in privacy. Discussions with service users verified that they feel they are treated with respect and their right to privacy is upheld at all times. DS0000028059.V329396.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Where appropriate, service users are supported to exercise choice and control over their lives, although the choice of planned daily activities are lacking. Service users are able to receive visitors at the home and there are no restrictions imposed on visiting unless requested by the service user. Service users are encouraged to bring personal possessions in with them. The meals provided at the home are well balanced, nutritional and freshly cooked on the premises. EVIDENCE: The home presented with a positive atmosphere in which staff, service users and visitors were observed to interact well with each other. The overall atmosphere was one in which the inspector felt the home had an ambience of family life. DS0000028059.V329396.R01.S.doc Version 5.2 Page 16 It was apparent during the inspection, that residents were aware of an unfamiliar face within the home, however this did not distract from the staff undertaking their duties and residents going about their daily activities. Whilst the inspector was informed that the home offers daily activities for those who require, no daily activities were evidenced during the inspection. Feedback received through speaking with service users, visitors and questionnaires sent out prior to the inspection evidenced that this is an area which is lacking. Whilst case tracking, it was evident that individuals are not always assessed as to their wishes and abilities for activities and leisure pursuits (See section headed Health and Personal Care). Discussions with members of staff informed the inspector that staff spend time with service users on a one to one basis an example being that of polishing their nails, general discussions etc, and the inspector was informed that the home offers to take residents on trips, but very little interest is shown. Regular activities suited to the residents’ needs and capabilities would provide them with stimulation and variety, for which a requirement has been made within this report. The inspector toured the kitchen, which was found to be in good order and food was stored safely and appropriately. The inspector discussed with the cook the arrangements for meals. Whilst the menu does not offer a second choice at lunchtime, the cook knows the service users’ likes and dislikes and will always undertake to make an alternative where the need arises. A choice of two hot meals at lunchtime had been offered, however this led to problems between service users, in that many with short term memory problems were unable to recollect what they had asked for and led to fraught meal times. The service users views were sought and acted upon; it was agreed that a set meal should be offered and where a service user had a dislike for the meal offered, another choice be prepared. Discussions with service users, around the meals offered at the home were very positive. Comments included; ‘I think the meals are excellent’, ‘there’s ‘quite a variety’, ‘very good’. The afternoon meal, on the day of inspection, consisted of Roast Turkey, mashed potatoes and freshly cooked vegetables followed by apple strudel and custard. The inspector observed assistance being given to those who required, in an unhurried, sensitive manner. Residents are able to receive visitors at any reasonable time, and are able to entertain them in their own bedrooms or in the communal lounges. Service users and those visiting verified that staff always make visitors feel welcome. DS0000028059.V329396.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a clear complaints procedure for residents to raise any concerns or complaints although they are not always recorded. Procedures are in place to safeguard service users from abuse. EVIDENCE: The inspector examined the complaints procedure, and discussed with the deputy manager how complaints are dealt with. Whilst viewing the complaints log it was noted that there had been no entries of any complaints or concerns raised for a few years. However, there had recently been a complaint/concern highlighted to CSCI’s attention when contacting family members, service users etc via questionnaires sent out as part of the inspection process. Whilst the complaint/concern had been addressed to the proprietor in writing, there were no records held in the complaints log pertaining to this instance. All instances of any written verbal or written complaints/concerns must be logged in the complaints log with details of any actions taken and the resultant outcomes. A requirement has been made within this report to ensure that all complaints be logged with any actions taken and the resultant outcomes. Discussions with service users highlighted that service users were aware that the home has a complaints/concerns procedure. However there were mixed responses as to whether they would in fact use it. A good practice DS0000028059.V329396.R01.S.doc Version 5.2 Page 18 recommendation is that the registered manager seeks ways to ensure dialogue is encouraged. It was noted that the contact details for the Commission for Social Care inspection, detailed within the complaints procedure need updating to reflect the new address and telephone number. Adult abuse awareness training is covered in the homes induction process and training in the Protection of Vulnerable Adults was delivered to all staff recently. Staff spoken to were aware of the procedure to follow in relation to Protection of Vulnerable Adults and all spoken to were aware of the homes whistleblowing policy and would use it if the need arose. Since the last annual inspection the Commission itself has received no such notification of any concerns, allegations or instances of abuse and neither has the home itself. DS0000028059.V329396.R01.S.doc Version 5.2 Page 19 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 and 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There are some improvements needed to ensure that the environment meets the residents needs. EVIDENCE: All communal areas and a selection of bedrooms were inspected, as was the cellar which was highlighted as a health and safety risk during the previous inspection undertaken in August 2006. There had been some progress made in relation to redecoration and addressing some of the issues highlighted during the last inspection although not all these had been addressed at this time. During the last inspection, it was apparent that the roof was leaking and had caused water damage to some of the décor in a number of bedrooms. Whilst the roof has now been repaired and redecoration of some rooms has taken DS0000028059.V329396.R01.S.doc Version 5.2 Page 20 place, there are still some rooms which need redecorating due to stained water marks on the wall paper. Whilst touring the home it was noted that a number of window frames were in a bad state of repair, the wood appeared to be rotting and therefore a requirement has been made to ensure that a risk assessment be undertaken by an appropriate person, that this be forwarded to CSCI and the findings be acted upon appropriately. The majority of combustible materials have been removed from the cellar, since the last inspection, however there was still some evidence of carpet, office chairs and other materials being stored in the cellar. As was required by the last inspection and that of the fire officer, the proprietor must ensure that combustible materials and objects be removed from the cellar, which houses the boiler, to ensure the health safety and welfare of both the service users and staff working at the home. Whilst viewing one service users personal space, it was noted that the WC failed to have a toilet seat, as was found during the inspection held in August 2006 that there was broken fittings on the wall which protruded from the wall and were not in use. These need to be removed so as not to cause harm to the resident and a toilet seat must be purchased and fitted. Damage to the wall in which the residents bathroom door handle has been knocking against the wall has resulted in a hole in the wall which needs filling. A door stop could perhaps be put in place to prevent any further damage. Whilst some residents may present with challenging behaviour, risk assessments must be put in place detailing how the risks are to be managed and regular assessments need to be undertaken to ensure that the home has the necessary resources and skills to meet these challenging needs. A further bedroom viewed evidenced that the carpet had not been replaced as was required during the last inspection and still remained odorous. The registered manager must ensure that the odour be removed or the carpet replaced. An empty bedroom, which was highlighted as needing redecoration during the last inspection, due to water damage, still evidences water damage is showing through. The inspector was informed that the room had been redecorated as was required however there are still signs of water damage which needs remedying. The en suite contained an unusable shower, in that the shower head had been removed and a nut placed in the shower hose due to the hose dripping. It is a requirement that these issues be dealt with appropriately prior to a service user being offered the room. Personal intimate belongings for one service user were found to be stored on view to others who may walk in that area of the home. Upon enquiry, the deputy manager immediately took all steps to ensure that these were stored DS0000028059.V329396.R01.S.doc Version 5.2 Page 21 appropriately to ensure the residents dignity and respect was not compromised. There is adequate provision of toilets, washing and bathing facilities throughout the home. The inspector observed that bedrooms were personalised with service users own belongings and adequate space is provided for the storage of their clothes and personal belongings. All service users rooms are provided with a TV aerial point, aerial and telephone point. The kitchen was observed as being clean, spacious and well looked after. DS0000028059.V329396.R01.S.doc Version 5.2 Page 22 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 good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complement of staff on the day of inspection appeared to be sufficient to meet the service users needs. No new members of staff have been recruited since the last inspection to ascertain whether there had been an improvement on the recruitment process and the necessary paperwork in place. However, discussions with the deputy manager around the recruitment process informed the inspector that robust procedures were in place and all necessary checks would be undertaken, prior to any new staff being offered employment. Three existing staff members files were viewed, one of which failed to contain an employment history and a verbal reference was given over the phone – no verification was evident. The second file contained all the necessary recruitment paperwork and disclosures. Whilst two references were evident, it is recommended that where references are received without a company stamp or with compliments slips, the reference be verbally verified and documented. DS0000028059.V329396.R01.S.doc Version 5.2 Page 23 Of the third file viewed, all was in order apart from one reference received, which had not been signed by the referee, for which it is recommended that where situations arise like this, the registered manager telephone for verbal verification and record this has taken place. The first file evidenced that the member of staff had undertaken training in food hygiene, fire awareness, safe handling of medications, infection control, protection of vulnerable adults, manual handling and had been provided with supervision regularly. The second file viewed, evidenced regular supervision had been provided, training had been undertaken in infection control, first aid awareness, oral health and optical awareness. There were no certificates on file to evidence that Protection of Vulnerable adult, manual handling or food hygiene training had been undertaken. However, food hygiene training has been arranged and the inspector was informed that all staff have recently undertaken POVA training. It is a requirement that staff personnel files contain documented evidence of all training undertaken. The third file, evidenced supervision had been undertaken as had the following training; first aid, protection of vulnerable adults, manual handling and back care, oral health, food hygiene and fire awareness and is undertaking the NVQ (National Vocational Qualification) Level 1. All members of staff undergo induction training, upon appointment to their posts, are provided with mandatory training and are offered ongoing training and support which equips them to meet the assessed needs of the residents within the home. Staff members are encouraged to undertake the National Vocational Qualification (NVQ) in care. The inspector was informed that 25 of the care staff possess NVQ level 2 or above in care with a further 5 signed up and working towards them. Future planned training includes 4 staff members undertaking dementia awareness training, three care staff and an assessor undertaking training in medication and one carer undertaking infection control. Whilst speaking with residents and general observation throughout the inspection care staff were meeting the residents’ care needs, although there was little evidence of staff offering quality time on a one to one basis. DS0000028059.V329396.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The registered manager has recently gained the Registered Managers Award, and has the necessary experience to run the home competently. In view of the findings during the inspection around meeting previous requirements , assessments of need, care planning and medication issues the home is not presently working in the service users best interests and protecting the health safety and welfare of residents appropriately. There are clear systems in place to protect the residents’ financial interests. DS0000028059.V329396.R01.S.doc Version 5.2 Page 25 EVIDENCE: The registered manager has recently gained the Registered Managers Award, as has her deputy and both have the necessary experience to run the home competently. The inspector was informed that a quality assurance process has not been undertaken as of yet although a system is in the process of being devised Previous requirements to ensure a systematic quality assurance programme be implemented were made in the last two reports and a further requirement has been made to address this. A requirement at the previous inspection was made to ensure that all showerheads within the home were regularly descaled and records maintained to evidence this. During this inspection evidence was provided to show that this has now been undertaken. Further requirements made were to service the boiler and undertake a legionnaires assessment. Both these requirements have been attended to and evidence was provided. Reports of monitoring visits undertaken by the provider are now undertaken regularly, however they do not evidence that appropriate monitoring is undertaken during these visits. It is recommended that the provider includes the areas listed in regulation 26 of the care homes regulations 2001 at each visit to ensure that sufficient details are gathered in relation to the service and the service it offers. It was noted that the certificate for employers liability insurance, which was on view in the home, had expired. The inspector was informed that insurance is in place and the home is awaiting the renewed certificate. The CSCI is notified under Regulation 37 of The Care Homes Regulations 2001 of any occurrence affecting the welfare of service users, and the deputy manager showed an awareness of what events need reporting The registered manager does not act as appointee for handling service users financial affairs, this is undertaken by family members or representatives. DS0000028059.V329396.R01.S.doc Version 5.2 Page 26 The inspector met discussed the management of the residents’ personal allowances. The systems and records were examined and found to be in good order and provided a clear audit trail to safeguard the residents’ financial interests. Quality assurance monitoring is not implemented as a core management tool. Previous requirements are not met in a timely manner and some continue to remain outstanding. A number of issues have been highlighted within this report which highlight that the home is not presently working in the service users best interests and protecting the health safety and welfare of residents appropriately; namely that of shortfalls around the issues of assessing and providing for residents’ social needs, the care planning process, gaps in the recording of the administration of medication and issues relating to the general environment. DS0000028059.V329396.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 2 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 3 2 x 2 x x 2 x 3 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x 3 x x 2 DS0000028059.V329396.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14(1)a,c Requirement The registered manager must ensure full assessments regarding social needs are carried out with all prospective service users and a signature is gained to evidence the service users’/representative have been included in the process. This requirement is outstanding from the previous report. Previous timescale of 1/10/06 not fully met. The registered manager must draw up a plan of care for the service user, identified during the inspection, without one in place. The registered manager must ensure that all service users have a full plan of care drawn up within 48 hours to ensure all staff are aware of the assessed needs and how to meet them. The registered manager must ensure any gaps in the recording of medication administration are documented appropriately and undertake regular medication DS0000028059.V329396.R01.S.doc Timescale for action 31/03/07 2 OP7 15 31/01/07 3 OP7 15 31/03/07 4 OP9 17 (1)a Schedule 3, 13(2) 31/03/07 Version 5.2 Page 29 audits, to reduce these types of errors. Requirements around accurate recording of medication records is outstanding from the previous report. Previous timescale of 01/10/06 not met. The registered manager must provide regular activities suited to the residents’ needs and capabilities to provide them with stimulation and variety. This requirement is outstanding from the previous report. Previous timescale of 1/01/07 not met. All instances of any written or verbal complaint/concern must be logged in the complaints log appropriately, with details of the actions taken and the resulting outcomes. The complaints procedure must be updated to reflect the Commission for Social Care Inspections new address and telephone number. The registered manager must arrange for a risk assessment to be undertaken, in regard to the windows, by a suitably qualified person Gaps in employment history, identified during the inspection, are to be pursued and recorded in the staff members personnel file. This requirement is outstanding from the previous report. Previous timescale of 1/09/06 not met. The proprietor must ensure to remove the remaining combustible materials and DS0000028059.V329396.R01.S.doc 5 OP12 16 30/04/07 6 OP16 22 31/03/07 7 OP19 23(2) 30/04/07 8 OP29 19 31/03/07 9 OP38 23(4) 31/03/07 Version 5.2 Page 30 objects from the cellar to ensure the health safety and welfare of service users. This requirement is outstanding from the previous report. Previous timescale of 1/10/06 not fully met. All maintenance issues identified within this report for improvement are to be attended to. This requirement remains outstanding from the previous report. Previous timescale of 15/10/06 not fully met. The registered manager must ensure to put detailed risk assessments in place, review assessments of needs regularly to ensure the home has the necessary skills and resources to meet the needs of a service user with challenging behaviour identified during the inspection. A systematic quality assurance programme must be implemented. This requirement remains outstanding from the previous report. Previous timescales of 31/7/05 and 01/10/06 not met. 10 OP19& OP21 22 31/05/07 11 OP7 13 & 24 30/04/07 12 OP33 24 30/04/07 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 It is recommended that the registered manager review the Care planning process to ensure a more detailed plan DS0000028059.V329396.R01.S.doc Version 5.2 Page 31 2 3 OP3 OP28 4 OP33 of action is included. It is recommended that that all residents’ nutritional status is assessed on admission using a nationally recognised tool such as the Malnutrition Universal Screening Tool (MUST). It is recommended in instances where references for prospective members of staff are received without a company stamp or with compliments slip, the reference be verbally verified and documented. It is recommended that the provider includes, during the monthly monitoring visits, the areas listed in regulation 26 of the care homes regulations 2001 at each visit to ensure that sufficient details are gathered in relation to the service and the services the home offers. DS0000028059.V329396.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Oxford Area Office Burgner House 4630 Kingsgate, Cascade Way Oxford Business Park South Cowley Oxford OX4 2SU 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 DS0000028059.V329396.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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