Inspection on 20/12/07 for The Old Rectory

This inspection was carried out on 20th December 2007.

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

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 08/07/08

The Old Rectory 24/09/07

The Old Rectory 24/11/06

The Old Rectory 30/01/06

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Old Rectory (The) Langton Matravers Swanage Dorset BH19 3HB Lead Inspector Catherine Churches Key Unannounced Inspection 10:00 20th December 2007 and 30th January 2008 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 Old Rectory (The) DS0000064826.V358769.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. Old Rectory (The) DS0000064826.V358769.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Old Rectory (The) Address Langton Matravers Swanage Dorset BH19 3HB 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) 01929 425383 F/P01929 425383 DAH Healthcare Ltd Mr James Edward Morgan Taylor Care Home 34 Category(ies) of Old age, not falling within any other category registration, with number (34) of places Old Rectory (The) DS0000064826.V358769.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: 2. 3. Old age, not falling within any other category (Code OP) The maximum number of service users who can be accommodated is 34. A maximum number of 23 service users who require nursing care may be accommodated. 24th September 2007 Date of last inspection Brief Description of the Service: The Old Rectory is situated in the centre of Langton Matravers, a rural village on the outskirts of Swanage. The village has a Post Office, newsagents, bakery, public house and church. There is a bus stop outside the home. The home is registered to accommodate a maximum of 34 people in the category of Care Home with nursing. A maximum of 23 people with nursing needs may be accommodated. Certain rooms, known to the owner and manager, may only be used for residential care, as they are too small to support good nursing care practice. Three rooms are registered as doubles. Accommodation is arranged on the ground and first floor levels in twenty eight single rooms and 3 double rooms. All of the rooms have ensuite facilities. There are two passenger lifts to the first floor enabling level access to all but four bedrooms. Fees at the time of the inspection ranged from £414 to £650 Old Rectory (The) DS0000064826.V358769.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This was an unannounced inspection, which took place in two parts. The first day was on 20th December 2007 and it was completed on 30th January 2008. In total nine hours were spent in the home undertaking the inspection. The large gap between the start and end of the inspection is due to the outbreak of an infectious illness amongst residents and staff. It was deemed not appropriate to complete the inspection until the home was clear from the infection. The current Registered Manager was on sick leave during the first part of the inspection and had left employment at the home by the second part of the inspection. The deputy manager was present throughout the inspection and is currently acting as manager. The inspection was brought forward in the schedule as relatives, social services and staff had raised concerns about the home. The purpose of this visit was to look at the concerns that had been raised and to monitor the homes compliance with National Minimum Standards. Compliance with requirements and recommendations made during the last inspection were also checked. The premises were inspected and a number of records examined. Time was also spent time observing routines within the home and talking with residents, visitors and staff. What the service does well: What has improved since the last inspection? Some refurbishment of the existing building has taken place as well as the completion of the building works for the new part of the home which provides spacious rooms with ensuite facilities and a large new lounge and dining area. Old Rectory (The) DS0000064826.V358769.R01.S.doc Version 5.2 Page 6 What they could do better: 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. Old Rectory (The) DS0000064826.V358769.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Old Rectory (The) DS0000064826.V358769.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 and 3 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People who have recently been admitted to the home have not been given the information they need to make an informed choice about where they wish to live. This means that they may not be where they want to be or that their needs are not being met. The home has not provided a written statement of terms and conditions or a contract and has relied on verbal information to inform residents about what is included in the fee, liability and overall care. Applications for admission to the home may be agreed without reference to a needs assessment, consideration of the specialist care the resident requires, or the skills, ability or the knowledge of the staff that will be caring for them. Old Rectory (The) DS0000064826.V358769.R01.S.doc Version 5.2 Page 9 EVIDENCE: We found that recent admissions to the home had not been undertaken in accordance with the National Minimum Standards. Pre-admission assessments had either not been done, undertaken after admission or not fully documented. There was no evidence that residents had been given appropriate information to enable them to make an informed choice about where they would live and they had not received a contract nor terms and conditions of residence. No letters had been sent to the residents to confirm that the home would be capable of meeting their care needs. Old Rectory (The) DS0000064826.V358769.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8, 9 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care plans still either do not reflect the care that is being delivered, give contradicting information or are incomplete. This means that the home cannot provide evidence that appropriate care is delivered at all times. The home needs to improve storage, handling, administration and recording of medicines so that residents are not put at risk. EVIDENCE: Care plans for six residents, some with nursing needs, were examined. These had either not been created for some newly admitted people or were out of date fro existing residents or those whose needs had changed. Those care plans that were in place lacked appropriate assessments such as risk, nutrition, skin integrity, mental health, moving and handling, behaviour management and continence. It was noted that daily records were not always up to date Old Rectory (The) DS0000064826.V358769.R01.S.doc Version 5.2 Page 11 and did not reflect the actual care that had been given. A number of people were very frail and fluid charts as well as turning charts had been introduced. The majority of these had not been properly completed. The visitor’s book confirmed that GP’s, District Nurses, chiropodists and other health professionals were visiting the home but individual records did not always reflect this nor were any instructions given as a result of visits recorded. The home had also taken in a large number of people from a home in the area which was closing. A number of these people had high needs and concern was expressed by the Commission that the home was not able to meet their needs. This was due to the fact that there were staff shortages, the building was not completely ready and not enough preparation was done to receive individuals and ensure that plans and equipment to meet needs were in place. The home has a medication policy but it needed updating so that staff have clear procedures to follow. Some residents looked after their own creams or inhalers. There were concerns about the storage of some medicines in residents’ rooms because of the tendency for some people to wander into and take things from other rooms. In addition there were serious concerns that the storage of medicines that staff give was unsafe. An immediate requirement was made about this and some other issues. A new trolley was delivered during the inspection and Mr Haigh agreed to improve arrangements for storing medicines by the next day so that they could be administered more safely. The nurse on duty prepared medicines for several residents at one time rather than preparing, administering medicines and signing the Medicine Administration Record (MAR) chart for one resident at a time to reduce the risk of medication errors. She said this was due to the fact that the trolley could not be taken round the home because of steps in the corridor. We checked 10 people’s records with the medicines in stock to see if they were given as prescribed, recorded and stored correctly. There were no records on several residents’ MAR charts of whether they had any medicine allergies, or not, to protect them. There was an audit trail for most medicines but the amounts some medicines in stock of did not agree with the records indicating errors in administration or recording. For example nurses had recorded giving 4 doses of one medicine when there was none in stock and the GP had stopped this tablet. The handwritten directions on the MAR chart were not countersigned as checked by a second person. We found that some medicines were not given as prescribed. For example staff had recorded giving one person twice the dose strong analgesic prescribed on two occasions. Another medicine was signed as given once a day when the directions stated “twice a day”. One person had half the dose of one of their medicines for 10 days because nurses had not noticed that the pharmacy had Old Rectory (The) DS0000064826.V358769.R01.S.doc Version 5.2 Page 12 supplied the wrong strength in error. One medicine was out of stock for 4 days. The quantities of medicines requiring special storage and recording agreed with the records. Staff had not recorded the administration of some creams and nutritional supplements so it was not clear if these treatments were given to meet people’s healthcare needs. We saw clear information about applying creams in two people’s care plans but information about another person’s medication had not been updated. There was insufficient space to store some medicines in accordance with legal requirements. There was no provision for storing medicines needing refrigeration and one person’s eye drops were not stored at the correct temperature to maintain their effectiveness. Staff had not recorded the date of opening 2 people’s eye drops so that they could be discarded 4 weeks after opening to prevent infection. There was no warning sign for oxygen on the door of the room used to store spare cylinders. Privacy and dignity was promoted by staff in as much as they were aware of the forms of address people preferred and knocked on doors before entering. However, staff failed to tell a partially sighted resident what her food was and where it was on the plate or even cut it up for them. The home has also failed to provide suitable locks on bedroom doors to enable residents to maintain their privacy and independence and had also not provided separate lockable spaces within their rooms. Old Rectory (The) DS0000064826.V358769.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Social, cultural and recreational activities are dependent on individual preferences and the resident’s capacity for involvement. Open visiting arrangements are in place enabling residents to retain contact with families and friends. Residents have the opportunity to choose their own lifestyle within the home and this means that their individual preferences and routines are respected. Dietary needs of the residents are well catered for with a balanced and varied selection of food available that meets resident’s tastes and needs. EVIDENCE: Old Rectory (The) DS0000064826.V358769.R01.S.doc Version 5.2 Page 14 It was founds that as a result of the building work, sudden intake of new admissions to the home and staff shortages, work on activities with residents took a backward step. However, by the second inspection an activities organiser had been employed for 24 hours per week and progress was being made with establishing individual interests and promoting social contact, stimulation and activity. There is a weekly communion service in the home, visiting entertainers, reminiscence therapy, visiting library service and various videos, music etc is available in the lounge. Recently introduced has been a “pat dog” scheme and storytellers. The visitor’s book was seen. This and conversations with staff confirmed that there is a constant stream of visitors to the home. Discussion with residents and staff as well as examination of records evidenced that residents are assisted appropriately to exercise choice and control over their lives. Residents confirmed that a suitable and varied diet is provided in the home. It was observed that one person with sight difficulties was not given appropriate assistance with their meal. The new kitchen has been completed and a new chef employed. Little progress has been made with the review of menus and introduction of choices for all meals but the Chef confirmed that it was his intention to do so. Old Rectory (The) DS0000064826.V358769.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The complaints procedure is not displayed or made widely available in the home. This means that residents, relatives and others involved in the home that may wish to make a complaint are not aware of how they should go about this or that they will be listened to and their concerns acted upon. Staff have either not received training or are in need of refresher training in the Protection of Vulnerable Adults. This means that they have little awareness of abuse and its many forms. Staff are also largely unaware of “Whistleblowing” procedures and the importance of reducing bad practice. EVIDENCE: Complaint records were examined. Two complaints had been made that the Commission were aware of. Neither of these was properly documented and the home had failed to follow its own policies and procedures; timescales for investigation had not been met and actions and outcomes had not been recorded. Old Rectory (The) DS0000064826.V358769.R01.S.doc Version 5.2 Page 16 At the time of the inspection the Local Authority was coordinating an investigation into the care of one named resident. Staff training records were examined. These could not provide evidence that all staff had had up dated and regular training in the Protection of Vulnerable Adults and Whistleblowing. The lack of training is also evidenced in an ongoing investigation under the Protection of Vulnerable Adults where staff delayed in reporting poor practice to the manager. Old Rectory (The) DS0000064826.V358769.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. 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. The home provides a physical environment that has the potential to meet the needs of the people who live there but at the time of the inspection does not. This is because the home was opened to new admissions before the building was completely finished and suitably equipped. The home is generally clean but there have been outbreaks of infection. Suitable equipment such as soap dispensers, paper towels, sluice and laundry facilities were not in place before the admission of new residents. Old Rectory (The) DS0000064826.V358769.R01.S.doc Version 5.2 Page 18 EVIDENCE: During the first part of the visit a number of matters of concern were highlighted to the owner and deputy manager. Many of these related to the new part of the building and should have been resolved before people were admitted. Noted items included: • Poor lighting in the hallways – this was put right by the second visit. • Poor heating leading to some areas being very cold – this was to with the commissioning of the new system and was put right by the second visit. • Fire doors wedged open – wedges were removed immediately. • Suitable locks had not been fitted to both new and existing bedroom doors – this was put right by the second inspection. • Lockable storage space within bedrooms, particularly the new ones, had not been provided. • The new extension to the home has not provided enough communal space. Additional space has to be provided by 31 march 2008. • The original part of the building is in a very poor state. There is a plan in place to upgrade these rooms over the coming months. • There was little provision for storage in the new parts of the home. This resulted in items being stored inappropriately in corridors and under the stairs. Actions were being taken by the second visit to create more space with an additional shed and better use of existing space. • New shower rooms and ensuite facilities had no soap dispensers, paper towels, storage space or hooks etc – very little action had been taken by the second visit. Work had just begun but the soap dispensers and paper towels should have been given a higher priority especially as they are so important in the prevention of the spread of infection. • Some of the new shower rooms are internal and have no windows for ventilation. It was noted that both residents and staff had commented that these rooms become very hot and unpleasant to be in. It was agreed that methods of ventilation would be investigated. • The telephone system had not been extended to the new part of the home. Consequently the person in charge had to run to the old part of the building to answer the telephone. This was clearly having a major impact on staff hours and the running of the home and could put lives at risk should emergency services need to be contacted by someone in the new part of the building. At the second visit it was confirmed that an order had been placed to extend the telephone system. • Evidence that the hot water temperature was regularly checked was not available. • The home had no suitable sluice facilities. A major concern in a home with nursing and for the management of infection control. An immediate requirement was issued for this. • The new laundry had not been completed and the home, with 28 residents was operating with only one domestic washing machine. Immediate requirements were served to address this. Laundry was sent Old Rectory (The) DS0000064826.V358769.R01.S.doc Version 5.2 Page 19 out until the new facility was complete. The new laundry was operational by the second visit. Old Rectory (The) DS0000064826.V358769.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. Staffing levels may not meet the needs of the people using the service, with their health and welfare being adversely affected. There are poor recruitment procedures with shortfalls in procedures and compliance with good practice designed to protect residents. EVIDENCE: Examination of the staffing rota showed that the home was running with one registered nurse on all shifts, five care assistants in the morning, four in the afternoon and three during the night. Staffing levels also fluctuated and the rota seemed to reflect the availability of staff rather than the staffing levels required by the needs of the residents. For example, staffing numbers reduced at the weekend although the same numbers of residents, with the same needs, were still living in the home. Staffing levels were of concern as so many weak areas such as resident care, poor medication practice and lack of care plans had been identified. An immediate requirement was issued requiring that the day shift had two Registered Nurses on the floor at all times. The acting manager was also Old Rectory (The) DS0000064826.V358769.R01.S.doc Version 5.2 Page 21 providing care during her shifts as manager. It was made clear that the management of the home must be supernumerary to the care staffing of the home. Five staffing files were examined. It was noted that some staff, appointed by the previous manager, did not have suitable checks undertaken. There was no system in place to check the PIN numbers of the Registered Nurses. No inductions had been given to any of the staff. Old Rectory (The) DS0000064826.V358769.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 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Management practices in the home are weak. The home does not have a registered manager. Development of quality assurance systems in the home has not progressed for a number of inspections meaning that the home cannot fully demonstrate that the home is run in the best interests of the residents. The health, safety and welfare of residents and staff is potentially being put at risk due to poor practice in relation to fire prevention and staff training. Old Rectory (The) DS0000064826.V358769.R01.S.doc Version 5.2 Page 23 EVIDENCE: The home put forward a manager who was registered in November 2007. This person was on sick leave on the first day of the inspection and did not return to their duties. The deputy manager, who is very newly recruited to the home, is acting as the manager but is not registered with the Commission. At the last three inspections it has been required that an annual development plan be created. This had not been done. Examination of fire records and staff training records revealed that some staff were overdue in training on the prevention of fire and action to take in the event of a fire. It was also noted that a number of fire doors had been wedged open making them ineffective. Records of staff training in first aid, basic food hygiene, health and safety and infection control were out of date or incomplete. Old Rectory (The) DS0000064826.V358769.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 1 1 1 X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 1 X X X X X X 1 STAFFING Standard No Score 27 1 28 1 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X X X X 1 Old Rectory (The) DS0000064826.V358769.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 OP1 Regulation 5(2) Requirement Timescale for action 31/03/08 2 OP2 5(1) 3 OP3 14(1) 4 OP4 14(1) Residents must be provided with the relevant information they need to make an informed choice about where to live. The homes statement of purpose and service user guide must be given to all residents and prospective residents. Every resident must have a 31/03/08 statement of the terms and conditions of residence at the point of moving into the home or a contract (which must be signed by both parties) if they are purchasing their care privately. A detailed assessment of all 31/03/08 health, personal and social care needs must be undertaken by people trained to do so and to which the prospective resident, his/her representatives and any relevant professionals have been party. All areas of need must be investigated and documented. Following the pre-admission 31/03/08 assessment it must be confirmed in writing with the prospective resident or their representative that the home is suitable for the DS0000064826.V358769.R01.S.doc Version 5.2 Old Rectory (The) Page 26 5 OP7 15(1) 6 OP8 12(1) 7 OP8 13(4) 8 OP9 13(2) purpose of meeting their needs. All residents must have a plan of care from the day of admission which sets out in detail the actions that must be taken by staff to ensure that all aspects of their health, personal and social care needs are met. Care plans must be reviewed regularly and any changes must be reflected in the care plan. If changes occur before the planned date of review then these must be added to the care plan. 20/12/07 This requirement is repeated for a second time. Resident’s health care needs must be fully documented and all care given must be recorded. 20/12/07 This requirement is repeated for a second time. Any risks to the health or safety of residents should be identified and so far as possible eliminated. Assessments and actions must be recorded. The Registered Person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received in the care home including ensuring that: All medicines are stored securely and safely at all times, including medicines in people’s rooms. Medicines are prepared, administered and recorded one resident at a time to reduce the risk of people being given the wrong medication. 31/03/08 31/03/08 31/03/08 31/03/08 - Old Rectory (The) DS0000064826.V358769.R01.S.doc Version 5.2 Page 27 9 OP9 13(2) 10 OP9 13(2) 11 12 OP9 OP9 13(2) 13(2) 13 OP10 12(4) 14 OP16 22(1) Medicines are stored at the correct temperature to maintain their effectiveness. - Directions for administering medicines are clear. - Medicines are available to give to people as prescribed. - There is a record of any medicines people are allergic to or that there are none known on or with the MAR chart. There must be a risk assessment for a resident who self-medicates that is regularly reviewed and updated to address the current risks and protect people. The medication policy must be updated so that staff have clear procedures to follow on all aspects of the handling of medication in the home. Medicines must be stored in accordance with legal requirements. The appropriate health and safety warning sign must be displayed where oxygen is stored. Doors to service users private accommodation must be fitted with locks suited to service users capabilities and which are accessible to staff in emergencies. 20/12/07 This repeated for a third time. There must be a simple, clear and accessible complaints procedure which includes the stages and timescales for the process, and that complaints are dealt with promptly and efficiently. All complaints must be recorded as well as any DS0000064826.V358769.R01.S.doc - 31/03/08 31/03/08 31/03/08 31/03/08 31/03/08 31/03/08 Old Rectory (The) Version 5.2 Page 28 15 OP18 12(1) 16 OP19 23 17 OP26 13(3) 18 OP27 18(1) 19 OP29 19 investigation and the outcome. Staff must receive training and regular updates on the signs and symptoms of abuse and the actions they should take should any form of abuse be suspected. Those items highlighted for attention in the “Environment” section of this report must be attended to. Infection control policies and procedures must be implemented. Staff must receive training and suitable equipment must be provided to assist in the process of infection control. Sufficient numbers of skilled and experienced staff must be available to ensure the safety and care of residents at all times. Thorough recruitment procedures including written references and satisfactory checks of the Protection of Vulnerable Adults register must be obtained prior to a person commencing duties in the home. A Criminal Records Bureau check must also be obtained. 31/03/08 31/03/08 31/03/08 31/03/08 31/03/08 20 OP30 12(1) 21 OP31 8(1) 22 OP33 24(1) All staff must receive induction 31/03/08 training in accordance with National Training Organisation targets to ensure that staff are trained and competent to do their jobs. The provider must appoint a 31/03/08 suitably qualified, competent and experienced person to manage the home and put them forward for registration with the Commission. Further work must be 31/03/08 undertaken with regard to quality assurance systems in the home in order to demonstrate that the home is meetings its DS0000064826.V358769.R01.S.doc Version 5.2 Page 29 Old Rectory (The) 23 OP38 13 aims and objectives and is run in the best interests of the residents. 20/12/07 This repeated for a third time. Evidence must be available that staff have received up to date training in health and safety, infection control, first aid, basic food hygiene and moving and handling. Records must be available to evidence this. Safe working practices must be implemented and adhered to. Fire doors must not be wedged open as this compromises the safety of those people in the home. 31/03/08 24 OP38 23 31/03/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP12 OP15 Good Practice Recommendations The improvements in activities and social contact should continue to be reviewed and expanded to suit the varied needs of those living in the home. Further work should be undertaken to ensure that menus provide a choice of meals and reflecting peoples needs and expectations. Appropriate assistance with meals must be available at all times. A plan must be developed and implemented to ensure that the minimum requirement of 50 of staff trained to NVQ 2 is achieved as soon as possible. 20/12/07 This repeated for a fourth time. 3 OP28 Old Rectory (The) DS0000064826.V358769.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Old Rectory (The) DS0000064826.V358769.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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