Inspection on 15/06/07 for The Old Rectory

This inspection was carried out on 15th June 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 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 Old Rectory 04/04/09

The Old Rectory 09/04/08

The Old Rectory 29/10/07

The Old Rectory 07/12/06

The Old Rectory 31/05/06

The Old Rectory 08/12/05

The Old Rectory 07/07/05

The Old Rectory 06/11/04

The Old Rectory 22/06/04

The Old Rectory 24/02/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE The Old Rectory 195 Wigan Road Standish Wigan Greater Manchester WN6 0AE Lead Inspector Judith Stanley and Kathleen Smethurst (support Unannounced Inspection 08:15 15th June 2007 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 Old Rectory DS0000005756.V335537.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 Old Rectory DS0000005756.V335537.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Old Rectory Address 195 Wigan Road Standish Wigan Greater Manchester WN6 0AE 01257 421635 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Megraj Jingree Mrs Premila Jingree Mrs Premila Jingree Care Home 10 Category(ies) of Old age, not falling within any other category registration, with number (10), Physical disability over 65 years of age (1) of places The Old Rectory DS0000005756.V335537.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Within the maximum number of 10 registered places , there can be up to10, OP and up to 1 PD(E) place. 7th December 2006 Date of last inspection Brief Description of the Service: The Old Rectory is a large detached property in Standish. The home is situated on the main road to Wigan and Standish town centres and is approximately five minutes drive from local amenities. The Home offers 8 single rooms on the first floor, of which 3 have en suite facilities and 1 shared room on the ground floor. Bathrooms and toilets are on the first floor and toilets are on the ground floor. There is limited parking at the front of the Home and a small garden area at the rear. The Old Rectory Care Home provides care and support for up to 10 male and female residents over the age of 65 years. The information provided to the CSCI prior to the inspection has the scale of fees at £300.00 to £400.00 per week, however when questioned the owner stated this was incorrect and that the scale of fees per week ranges from £300.12 to £420.00 a £15.00 a week top up charged is incurred. Additional charges are made for hairdressing, newspapers, chiropody, alterative therapy and toiletries. The Old Rectory DS0000005756.V335537.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection of The Old Rectory took place on the 15 June 2007 and included a site visit. The home did not know that the inspection was to take place. Two inspectors carried out the inspection, from 08.15am until 15.15pm. The inspectors looked at records the home holds on the residents (care plans), and other records it needs to keep to ensure the home is being properly run. The inspectors looked around the building and spoke with residents, staff and visitors throughout the course of the inspection. Both the manager and the owner were surprised to see the inspector asking “ has there been a complaint ”. Their approach was as though they were expecting the inspector to visit the home for some other reason than for a routine inspection. To find out more about the home comment cards were sent to residents, relatives and other people who visit the home, for example district nurses and doctors asking them what they thought about the home and the care provided. Seven service users and nine relatives returned comment cards. One resident wrote, that staff are usually available when she needs them and that she usually receives medical support when needed. The resident also commented on the activities that sometimes there are activities in the home and that there had been more lately, but she would like to taken for short walks. The resident said lunches were good, that the home is clean, however she did not know how to make a complaint and to whom if necessary. One resident’s questionnaire appears to have been completed by a relative as one quotes “ We are very pleased with all things in the home”. Other comments included, “ I am happy here, I enjoy the company of both staff and residents. I feel much safer here than when I lived alone”. A relative’s comment to the question about information prior to someone being admitted to the home included, “ nothing was given to us in writing there was only verbal information”. With regard to the question about the home giving the support and care to their relative, a comment was made that, “ There is sometimes no toilet roll in the en suite and one occasion the light bulb in the bathroom had failed. It was evening and the member of staff on duty did not know where there was a new bulb, so I had to take one from another light to replace it”. To the question, ‘Do the care staff have the right skills and experience to look after people properly?’ a relative has commented, “ Not sure, the owner and his wife have a good command of English but some of the staff employed have not. We have no way of knowing what their qualifications are but clearly they can not converse with the residents if their language skills are poor”. The Old Rectory DS0000005756.V335537.R01.S.doc Version 5.2 Page 6 Comments have been made about the lack of physical exercise and no lockable space for personal belongings in resident’s rooms. Other relatives are in the main satisfied with the care provided, with one relative stating, “They do an excellent job”. There were no returned comment cards from visiting professionals. During the course of the inspection the home’s managers was given, by the inspector, The Caution under Code 10.4 of the Police and Criminal Evidence Act (PACE) for her failure to produce clear and correct documents, namely duty rosters under Schedule 4 Regulation 17 (2) 7 of the Care Homes Regulations 2001 and for failure to produce correct information for at least one employee of: the position he/she holds at the care home, the work that he/she performs and the number of hours for which he/she is employed each week. Schedule 4 17 (2) 6 (e) of the Care Homes Regulation 2001. What the service does well: What has improved since the last inspection? What they could do better: The Old Rectory DS0000005756.V335537.R01.S.doc Version 5.2 Page 7 The home’s manager must ensure that all residents contracts are reviewed with the correct rate of fees charged shown and any additional charges including any top up fees are included. The home’s owner and manager or a member of staff undertakes the cleaning and although the home was clean it would benefit from the employment of domestic staff that works regular hours. An alternative to the main meal served should be available at all meal times. Residents should be made aware of the choices. The resident’s dignity must be maintained at all times, this specifically relates to the use of kylies sheets on the lounge chairs. All staff must receive recognised, certified training in the protection of vulnerable adults and in other areas of mandatory training for example food hygiene and fire training. The manager must ensure that all new staff completes a recognised induction programme. The manager must ensure that the duty rosters are clear and give precise details of which staff are on duty, at what times and in what capacity and who is covering the sleep in duty. The manager should ensure that a verbal handover is given at the change of each shift to make sure that all staff are aware of what gone on the shift and if there have been any issues or problems. 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 Old Rectory DS0000005756.V335537.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Old Rectory DS0000005756.V335537.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 3 were assessed. Standard 6 does not apply, as the home does not provide intermediate care. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. All residents are provided with a contract, however these must be reviewed to ensure that residents and/or their representatives are fully aware what fee is charged and what does the fee cover. EVIDENCE: The contracts of two permanent residents and one respite resident were examined. On one residents contract (dated 08/01/07) there were no details of the actual fees paid. The relative of this resident returned a questionnaire to the inspector, which stated, “ We have never seen anything in writing regarding her account, we pay monthly by standing order but previously paid cash or cheque. I took along receipts to get them signed. The notice of the The Old Rectory DS0000005756.V335537.R01.S.doc Version 5.2 Page 10 increase of fees was verbal and my requests of written notice was not acted upon”. The contract of another resident was in place with a weekly fee of £350.00 written on the contract. The contract was signed and dated 11/11/05. There was no evidence that the contract had been updated to reflect any changes in the fee payable. It was discussed at the last inspection of 07/12/06 about fees being paid in cash and when the inspectors asked for receipts the manager could not produce any. The manager told the inspectors that it was a mistake on the contract and that no cash payments were ever received. The relative’s questionnaire and actions and the manager’s previous responses are conflicting. The manager stated there had been no long-term admissions since the last inspection. The file of a resident admitted for a period of respite care was examined; “An assessment for good planning” was in place. This document had been signed and agreed by the resident. The document contained all the details required prior to admission, for example personal care and physical well-being, diet and weight, sight, hearing and communication, oral health, foot care, mobility and dexterity, history of falls, continence, medication, mental state and cognition, social interests, hobbies, religious and cultural needs and personal safety and risk. The Old Rectory DS0000005756.V335537.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8, 9 and 10 were assessed. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans were clear and concise and provide staff with the information they need to meet the needs of the residents. EVIDENCE: Three care plans were chosen for inspection. Since the last inspection on 07/12/06 new care plan documents had been introduced. This is a detailed document and contains information relating to residents personal, social and health care needs and religious preferences. Details in the care plan showed other information, for example next of kin, doctors, contact numbers, social worker, details of past and present medical history were available. Other information in the care plans covered the homes assessment, weights, waterlow- pressure prevention charts, risk assessments for fall and movement around the home and a record of doctors, chiropodist and other health care professionals visits. The care plans had been reviewed monthly as required. The Old Rectory DS0000005756.V335537.R01.S.doc Version 5.2 Page 12 On one returned questionnaire a comment has been made by a relative that some staff do not have good command of the English language. The manager must ensure that all care staff can fully understand what is written in the care plans to make sure the needs of the individuals can be fully met. The medication was inspected and the requirements made by the CSCI pharmacist inspector at the last inspection on 07/12/06 had been suitably addressed. Procedures were available to demonstrate the safe handling of medication. Drugs had been suitably dispensed and were recorded on the individuals MAR sheet (drug record). A sample of the MAR sheets was inspected and no errors noted. Currently there are no residents receiving any prescribed controlled drugs. Lamb’s chemist provides medication and the pharmacist visits the home regularly to undertake an audit. The last audit took place on 25/01/07 and no concerns were raised. The home does not have a separate medications fridge but any medication, which requires being kept in a fridge, is stored separately in the kitchen’s domestic fridge. Systems to record the receipt of and the return of medication were in place. On the day of the inspection staff were heard speaking kindly and respectfully to the residents. There were however adverse comments that were brought to the attention of the inspector regarding both the manager and the owner. Residents were seen to be nicely dressed, in clean well-maintained clothing. Resident’s hair was neat and tidy and some had had their hair set. The home now has a hairdresser that visits on a regular basis. As at the last inspection of 07/12/06 there are issues surrounding the use of kylie sheets (sheets that soak up urine) being placed on every chair in the lounge. This poor practice was observed again at this inspection when one inspector arrived at the home before the manager came on shift. The kylies were promptly removed by the manager when she arrived at the home. The inspector asked if they had been removed for the inspectors benefit, the manager said, “ No they were smelling so I have sent them for washing”. If this were the case they would have been better washed at night when the chairs in the lounge were not being used, as according to the manager some residents have ‘accidents’ so if all chairs have a kylies on them it saves embarrassment. These look unsightly and are undignified and can highlight a resident has a continence problem which could cause embarrassment for that individual and for those residents that do not have a problem they should not be subjected to this indignity. Alternative arrangements should be made to deal with any continence issues. The Old Rectory DS0000005756.V335537.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 were assessed Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The home still needs to improve the range of activities provided and the meals served to ensure that residents are offered more variety and choice. EVIDENCE: An activities programme was in place. Some improvements were noted on that two recent trips had taken place (May and June 2007) to local garden centres. Also residents individual activity records show some residents had had walks outside (some unaccompanied). The advertised activities included the following: Newspaper discussion, exercises, bingo, board games, cards, walk to local shop, chair ball, hairdressing (this should not be classed as an activity as it is part of personal care and grooming), quiz and music. The individual activities residents take part in are also recorded in their individual files. Activities recorded include the following bingo, dominoes, meals out, shopping, one to one activity (does not state what), newspapers, television, not all residents can see the screen from where they sit due to the location of the television), hairdressing and exercise. Religious needs appear to be met The Old Rectory DS0000005756.V335537.R01.S.doc Version 5.2 Page 14 with religious service taking place in the home. On the day of the inspection the morning activity (quiz) was observed, residents appeared to enjoy the activity despite the length of time it went on for and the questions initiated discussion between the resident and the staff member running the activity. A visitor to the home was observed playing the piano for the residents in the afternoon. Visitors were seen to come to the home at various times during the inspection; this was also evidenced in the visitor’s book. The inspector spent time speaking with two relatives who were visiting from overseas. They told the inspector that they were very satisfied with the care provided to their relative and they had no concerns. The choices made by residents depends upon their mental capacity, one resident spoken with is very clear about how she wishes to spend her day, she told the inspector she enjoys the privacy of her own room and likes to listen to the radio and is an avid reader. At two mealtimes it was observed that the manager walked into the dining room and immediately switched loud music on. The three residents in the dining room for breakfast were not asked if they would like the music on, nor were residents consulted at lunchtime. The menus were available for inspection and are planned over a four-week cycle. Breakfast is not served on a flexible basis; apart from three residents in the dining room all other residents had their breakfast in their rooms. All residents were given cereals and toast (no preserves) and mug of tea. The breakfast menu shows a range of choices including, porridge, cornflakes, ready break, weetabix, toast with jam or honey, boiled eggs, fruit juices, tea, coffee or milk and a cooked breakfast available on request. Comments referred back to the inspector indicated that the choices may be written but they are not offered. With regard to choices one-comment states, “You must be joking”. On the day of the inspection there was no evidence to show that residents had been asked what they would like for breakfast and staff were seen just taking up trays to residents rooms. Breakfast was uninteresting with no staff intervention or conversation. Lunch is the main meal of the day, the lunchtime meal was written on a chalkboard in the dining room. Most residents came into the dining room for lunch, which was fish, chips and steeped peas (processed fish and frozen chips) or eggs and chips followed by pears or bananas and custard and orange juice to drink. One inspector observed lunch and found the portions of food to be adequate and that residents were not rushed and were given time to eat their meal. There was little interaction from staff with residents during the course of the meal. Meal times are meant to be a social time for residents, but this was not the case. The Old Rectory DS0000005756.V335537.R01.S.doc Version 5.2 Page 15 Some of the lunchtime meals needs to be reviewed as on one day it is chicken chasseur or roast chicken, another fish in breadcrumbs or poached fish, on one Sunday it is roast turkey (no options are available on Sundays) and on Monday it is either chicken fricassee or poached chicken followed on Tuesday by lamb chops or turkey escalope. An alternative to the main meal would be better if it was something completely different and not consisting of the same meat and vegetables. A lighter afternoon tea is served; comments regarding the teatime meal have been brought to the inspector’s attention. Again it would appear that no choices are offered despite these being indicated on the menu and onecomment states. “You get what you are given, like it or lump it”. This was discussed with the owner and the manager who rejected these comments as incorrect and stated that they have discussed this with the residents and they are happy with the meals served at teatime. There was no evidence to show that this discussion had take place. The supper time menu is displayed in the dining room and it states residents are offered teacakes, crumpets, scotch pancakes, potato cakes, fruit cake, cakes or scones, biscuits, with a choice of drink including tea, coffee, horlicks, hot chocolate, ovaltine or milk. Again comments made to the inspector reject these items were available. The inspector on checking the supplies was shown that there were cakes and biscuits available and was shown a small jar of drinking chocolate and horlicks by the owner. However the owner could not produce other goods for example crumpets and told the inspector, “ if somebody wants crumpets, I would go to the shops for them”. Consideration needs to be given to mealtimes in general; although it is good that residents have the choice to dine in their rooms it can also isolate them eating and socialising with others. It was noted that the carpet in the dining room was heavily stained and in need of cleaning or replacing. The Old Rectory DS0000005756.V335537.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 were assessed. Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints system in place to ensure that complaints and concerns will be taken seriously and acted upon. Systems for protecting residents from abuse are not satisfactory therefore potentially placing residents at risk from abuse. EVIDENCE: A new complaints book had been introduced which details the nature of the complaint, the action taken and any further suggestion by either party. There has been one minor complaint made to the home by a resident on 11/04/07, this was suitably dealt with by the home’s manager. There have been no complaints made to the CSCI since the last inspection. Care should be given to ensure the confidentiality of all parties when logging a complaint and its outcomes as the complaints are logged in a book, which would allow others to read what is written. On checking staff training for protection of vulnerable adults the inspectors found what appeared to be ‘homemade’ certificates in the training file. These had been signed by the home’s manager on the 05/05/07. The inspectors The Old Rectory DS0000005756.V335537.R01.S.doc Version 5.2 Page 17 asked the manager what training she had given and the manager showed the inspectors a basic workbook on the protection of vulnerable adults. The workbook would be satisfactory as part of the homes induction but not as a thorough training programme on protecting vulnerable adults. Staff need to be aware of the local authorities policies and procedures and undertake the relevant training. The homes manager said that both the owner and herself were suitably qualified to deliver training, however when the inspectors asked for evidence to substantiate this were informed that the college had lost their certificates. The manager tried to contact someone in relation to this during the inspection, but no information to verify the situation has been sent to the CSCI. The Old Rectory DS0000005756.V335537.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, 21,24 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The standard of the environment is satisfactory; some improvements are needed to make this a more homely and comfortable home for resident living there. EVIDENCE: From a tour of the premises, it was seen the home was clean and tidy and no odours were detected. Some improvements had been made with new windows being installed at the front of the home. The Old Rectory DS0000005756.V335537.R01.S.doc Version 5.2 Page 19 The dining room carpet requires cleaning or replacing as it was heavily stained and is coming apart at the seams near the door. It was noted that new curtains had been hung. The lounge has also had new curtains, however these were seen to be hanging down off the rail. The lounge has had no further refurbishment and it was noted that when the inspector arrived at the home at 08.15 a.m. all the chairs had kylies on them and the chairs arms were covered with white, chair arm covers that were ripped and full of holes. These looked unsightly and both the kylies (bar one) and the chair arm covers were swiftly removed by the manager when she came on duty. The bedrooms were inspected and were seen to be clean and tidy. Residents had personalised their rooms with their own possessions brought with them from home. A comment has been made to the inspector that her relative would like some lockable storage space to allow personal items to be locked away. The manager is required to check whether all residents would like some lockable storage space and if not this should be documented in the care plan. Bathrooms were clean and there was no evidence of communal toiletries on show. One bathroom has a hoist for assisted bathing, the other bathroom (beige suite) is a domestic bath with no adaptation. On the day of the inspection the inspector found that no hot water was coming out of the tap. The owner was informed of this. The home still does not employ proper domestic staff and the home is still cleaned by the owner and the manager and on occasion care staff are rotered as cleaning for a few hours. The home does not have a laundry person; this duty is carried out by the staff. The garden area to the rear of the home requires attention. The grass was long and in need of cutting. The area needs to be made attractive to allow residents to sit out on nice days. The Old Rectory DS0000005756.V335537.R01.S.doc Version 5.2 Page 20 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 poor. This judgement has been made using available evidence including a visit to this service. Residents cannot be assured that the staff have the necessary skills and are suitably trained and competent to do their jobs. EVIDENCE: The duty roster for week commencing 10/06/07 was examined. Concerns were raised in that there was no indication of who provided sleep in cover for the week. It was also noted that on the 15/06/07 one member of staff was rotered to work from 09.00 a.m. until 13.00 p.m. and then was to return at 20.00 p.m. to complete the night shift. This member of staff had not been afforded a long enough break between shifts. It was also noted that some staff are working long hours, for example one member of staff worked 70 hours in one week in addition to sleep in duties. It was also understood that two overseas workers live in the flat where the sleep in duties also take place. One inspector asked how the people living in the flat can lead a ‘normal life’ for example playing music, enjoying a late night The Old Rectory DS0000005756.V335537.R01.S.doc Version 5.2 Page 21 when off duty when a member of staff is trying to sleep. The manager of the home categorically told the inspector, “ I don’t care”. It was also noted that a member of staff was apparently working in the home on a student visa and was rotered to work 48 hours but the rota did not indicate which hours she was working on a supernumerary basis as a student. A further sample of duty rosters were examined of which none contained details of the designation of staff on duty for example senior, cook domestic etc. The manager told the inspectors that the duty rosters were wrong and then tried to retract what she had said. The contract of one of the students indicated that she worked 35 hours a week as a senior care assistant, as this person is a student and is meant to be studying for NVQ level 2 in care, the inspector questioned how can she have the necessary experience to be classed as a senior carer. Another contract for the same person indicated that she works 30 hours a week. This person lives in the flat upstairs. The manager told the inspectors that the contracts were wrong and left the room returning 10 minutes later with another signed contract stating that this member of staff works 20 hours a week. At this time the inspector cautioned the manager under PACE (Police and Criminal Evidence Act) that she was advised not to say anything else that could be used in evidence against her. The home’s recruitment polices and procedures had improved and of the staff files checked they were seen to contain written application forms, 2 written references, Criminal Records Bureau checks (CRBs), statement of terms and conditions and other forms of identification. It was difficult for the inspectors to decipher what training staff had actually done. For new staff there was no evidence in files to demonstrate that they had completed a satisfactory induction programme. There was evidence to support that moving and handling training had been completed by a recognised training company. Some staff had undertaken medication training. In the training file there were ‘homemade’ certificates that indicated that the home’s manager had delivered training through the use of workbooks and videos for protection of vulnerable adults, basic food hygiene and fire awareness. The manager was unable to provide the inspectors with evidence that she was qualified and competent to deliver this training. The manager of the home must produce a training matrix that indicates clearly what training has been completed and when refresher dates are due. The Old Rectory DS0000005756.V335537.R01.S.doc Version 5.2 Page 22 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, 36 and 38 were assessed Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Residents can not be assured that they are living in a home which is being run by a person who is fit to be in charge, of good character and able to discharge her responsibilities fully. EVIDENCE: The manager is a qualified nurse and has the NVQ level 4 award. The management of the home must improve to ensure that standards are met and maintained, with particular regard to resident’s contracts, staff training and staff induction, duty rosters and factual information on staff contracts. The Old Rectory DS0000005756.V335537.R01.S.doc Version 5.2 Page 23 The home is not being run by a competent skilled manager who is adept at fostering an atmosphere of openness and respect, in which residents, family and staff all are valued and feel their opinions matter. Both the owner and the manager arrived late for the start of their shift, according to the duty rota the manager should have started at 08.00 a.m. but arrived at 08.30 a.m. and the owner should have started his shift at 08.00 a.m. and arrived at 09.00 a.m., this meant the night staff had to stay on duty longer. The inspector noted there was no verbal handover by staff to the manager at the change of shift. There is a new quality assurance system in place. If and when this is completed properly it will cover areas of training, supervision, inspection requirements, complaints, feedback from professional visitors to the home, staff and resident/visitors questionnaire, meetings, risk assessments, quality of the environment, medication, health and safety, accidents, employment checklist, annual development plan, overall year plan and annual report to the CSCI. As this in the preliminary stages quality assurance was not fully inspected on this occasion and will be assessed at the next inspection. The manager of the home stated that the home does not hold any money on behalf of the residents and that; this is dealt with by the resident’s family. There was some evidence of staff supervision now taking place and being recorded, however not all staff had received supervision as required. The pre inspection information provided to the CSCI detailed that maintenance checks had been undertaken. Certificates were checked on site and verified that: water testing (legionella) was carried out on 03/08/06, the electric wiring on 26/04/07, the gas certificate appears to be overdue as this was issued on 10/04/06, the manager is required to check this, the latest fire drill was carried out on 19/04/07. Other fire checks are routinely completed and recorded. The home’s accident book was checked and accidents and incidents had been suitably recorded. There have been two notifiable accidents brought to the attention of the CSCI since the last inspection. The Old Rectory DS0000005756.V335537.R01.S.doc Version 5.2 Page 24 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 2 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 1 2 x x x x 2 x 2 STAFFING Standard No Score 27 1 28 1 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 x 2 x 3 2 x 2 The Old Rectory DS0000005756.V335537.R01.S.doc Version 5.2 Page 25 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 OP2 Regulation 5 (1)(b) Requirement All residents must be provided with an up to date contract detailing the fee charged, any top up charges made and any additional charges made above the fee. (outstanding from the last inspection of 07/12/06 with a timescale of 28/02/07) The manager must ensure that the resident’s dignity is maintained at all times: Specifically referring to the use of kylies sheet on lounge chairs. (outstanding from the last inspection of 07/12/06 with a timescale of 31/01/07) Residents must be offered a choice of meals that which are available and preferences must be recorded. (outstanding from the last inspection of 31 May 2006 with a timescale given of 28/07/06 and from the inspection of 07/12/06 with given of 31/01/07). In order that staff have the DS0000005756.V335537.R01.S.doc Timescale for action 10/08/07 2. OP10 12 (4)(a) 10/08/07 3. OP14 16 (2)(i) 10/08/07 4. OP18 13(6) 10/08/07 Version 5.2 Page 26 The Old Rectory knowledge to detect and refer abuse, and in order to protect residents, all staff must be trained in the Protection of Vulnerable Adults. (outstanding from the last inspection of 31 May 2006 with a timescale given of 28/07/06 and from the inspection of 07/12/06 with a timescale given of 28/02/07). 5. OP27 18 (1) (c) (i) The manager must ensure that all staff receive training appropriate to work they perform: Specifically in moving and handling, fire safety, food hygiene, protection of vulnerable adults and first aid. Induction training must be completed by new staff. (outstanding from the last inspection of 07/12/06 with a timescale given of 28/02/07 The manager must ensure that a copy of the duty roster of persons working at the care home, and a record of whether the roster was actually worked. The manager must ensure that there are suitably qualified, competent staff working at the care home as are appropriate for the health and welfare of the residents. (outstanding from the last inspection of 07/12/06 with a timescale given of 28/02/07) The registered manager must ensure that staff receive training appropriate to the work they are to perform including structured induction training. DS0000005756.V335537.R01.S.doc 10/08/07 6. OP27 17 (2) Sch 4 10/08/07 7. OP28 18 (1)(a) 10/08/07 8. OP30 18 (1)(c ) (i) 10/08/07 The Old Rectory Version 5.2 Page 27 9. OP36 18(2) All staff must receive formal supervision at least 6 times per year to ensure they receive the support, direction and guidance needed to care for residents. (outstanding from the last inspection of 31/05/06 with a timescale given of 28/07/06 and from the inspection of 07/12/06 with a timescale given of 28/02/07). 10/08/07 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 OP15 Good Practice Recommendations The registered person should ensure that all residents are provided with details of the menus each day in writing or verbally. Residents should be offered a choice at mealtimes, including a cooked breakfast. The registered person should ensure that the grounds are kept tidy. The registered person should ensure that residents have lockable storage space for their personal belongings The registered person should ensure that staff are provided with a suitable break between shifts. The registered person should ensure that staff are issued with correct terms and conditions of employment. The registered manager should make sure that she and other staff arrive on time to start their shift and a full handover is given. The registered person is to ensure that the gas certificate is renewed. 2 3 4 5 6 7 OP19 OP24 OP27 OP27 OP31 OP38 The Old Rectory DS0000005756.V335537.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Manchester Local office 11th Floor West Point 501 Chester Road Manchester M16 9HU 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 Old Rectory DS0000005756.V335537.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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