Inspection on 07/12/06 for The Old Rectory

This inspection was carried out on 7th December 2006.

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 15/06/07

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 Kath Smethurst (Support Inspector) Unannounced Inspection 7th December 2006 08:00 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.V322218.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.V322218.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.V322218.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. 31st May 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. 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 current scale of fees per week ranges from £300.12 to £420.00 a £15.00 a week top up charged is incurred. The Old Rectory DS0000005756.V322218.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection to The Rectory took place on 7 December 2006 and included a site visit. Two inspectors carried out the inspection, from 08.00 am until 4.00 pm. The inspectors looked at records the home holds on residents (care plans) and other records the home needs to keep to ensure that the home is being run properly. The inspectors looked around the building and checked bedrooms, bathrooms and communal areas. To find out more information one inspector spoke at length to 3 residents, and one visitor. The owner, manager and 2 staff were also spoken with. Comments cards, asking residents what they thought about the home were left in every resident’s bedroom and comment cards have been sent out to nine residents next of kin for their views and opinions of the care and facilities provided at the home. Comments from residents returned comment cards include; many promises have been broken such as the number of baths, trips out, being accompanied on walks and the entertainment programme. “There is not enough care staff are on duty to have time for a chat and the managers don’t listen to you”. “Request for medical attention is ignored and requests for other services like visits from the optician have also been ignored”. With regard to the activities one comment made states “Nothing ever happens”. Two comments have been made about the teatime meals, these have been described as, “Becoming less appetising, with no choices offered”. One comment card has described the manager as “intimidating”. Another completed comment card states that, “in the main the family are 70 happy with the care, but please do not divulge my name as I don’t want to be in any discussion with the home”. This type of comment is worrying as it implies that the relative is worried about voicing any concerns or approaching the manager. Another relative wishes to complement the home for their continued care and kindness. The manager said there had been no complaints made to the management of the home since the last inspection, however information received by a visitor to the home states, that they have had reason to raise concerns with the manager about several issues, but this was not recorded. Telephone calls to CSCI by an anonymous caller raised concerns about the temperature of the home, the lack of activities provided, the meals served at The Old Rectory DS0000005756.V322218.R01.S.doc Version 5.2 Page 6 teatime and that the lounge and dining room were dark. Also concerns have been raised about the owner’s children being left outside in the car whilst the owner was inside the home for some time. The owner confirmed he was delivering shopping to the home and was not on duty. What the service does well: What has improved since the last inspection? What they could do better: The statement of purpose and the service user guide needs to be amended to contain all the required information and must give factual information of what services the home provides and the facilities offered. The home’s manager must ensure that all the resident’s contracts are reviewed with the correct rate of fees charged shown and any additional charges including any top fees are included. The home’s manager must ensure the home is heated throughout to a temperature (at approximately 70°F) that enables residents to sit and be warm and comfortable at all times. The window frame in the lounge requires attention as there is a draft blowing in and residents sitting with their backs to the window can feel the draft. The home’s manager should try to employ a qualified hairdresser to visit the home and should cease from carrying out this task herself and being in receipt of any cash payment for this service. The home’s manager and staff must ensure there is a plan of activities that delivers a wide, fulfilling range of activities that are appropriate and suited to the capabilities of the residents. The home’s owner and manager undertake the cleaning and although the home is clean it would benefit from the employment of domestic staff. This The Old Rectory DS0000005756.V322218.R01.S.doc Version 5.2 Page 7 would free the manager to manage the home more efficiently, plan and deliver staff supervision and organise activities for the residents. The menus must reflect the meals served or if any changes are made this must be documented. An alternative to the main meal served should be available at all meal times. Residents should be made aware of the choices. The manager must ensure that staff receive regular supervision at least 6 times a year. The manager must ensure that all staff is suitably trained and competent to do their jobs. All medication must be administered in the correct manner, for example a resident had two bottles of the same medicine open and both being dispensed. The home’s manager must not allow staff to work in the home without vetting them properly. All staff must have Criminal Records Bureau check (CRB) which should be applied for by the manager of the Old Rectory for all staff and is reminded again that CRBs are not portable and cannot be used when applied for by another home. All staff must be trained and competent to do their job to ensure that they can meet the needs of the residents with regard to personal care and health and safety. There must be an adequate number of staff caring for the residents at all times. There is no evidence to show that the manager has any supernumery hours to carry out management tasks. The manager is counted in the staff hours. It was evident from the lack of formal staff supervision, the lack activities and the poor record keeping, no quality assurance systems that these arrangements need to be reviewed. The practice of one waking member of staff needs to constantly reviewed and the CSCI kept informed of any further changes. One member of staff lives on the premises, and if not on duty at night (as the sleep in) should not be called on to assist in caring for the residents. The manager must ensure that the CSCI is kept informed of any accidents, injuries or incidents that occur. From 05/10/06 to 06/12/06 there were at five incidents that the CSCI should have been made aware of. Please contact the provider for advice of actions taken in response to this The Old Rectory DS0000005756.V322218.R01.S.doc Version 5.2 Page 8 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.V322218.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 The Old Rectory DS0000005756.V322218.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): 1,2 and 3 were inspected. Standard 6 does not apply at The Old Rectory Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The systems for providing residents with information about the facilities available and the current fees and services are not satisfactory; therefore residents and relatives do not have access to current information. EVIDENCE: The statement of purpose and the service user guide needs to be amended. There appears to be some confusion of what should be contained in the documents. The statement of purpose (refer to schedule 1 of the National Minimum Standards for Older People (NMS) should contain the name and address of the registered provider and manager, the relevant qualifications and experience of the provider and the manager, the number and relevant qualifications of the staff, the organisational structure of the care home, fire precautions, arrangements for dealing with complaints, including the address The Old Rectory DS0000005756.V322218.R01.S.doc Version 5.2 Page 11 and telephone number of the Commission for Social Care Inspection. Other information stated in Schedule 1 of the NMS for older people should be included to provide residents and their supporters with as much information as possible to help them make an informed choice about moving into the home. The service user guide should contain a brief description of the services provided, including the individual accommodation and communal space provided, relevant qualifications of and experience of the registered provider, manager and staff, the number of places provided and any special needs or interests catered for: a copy of the last inspection report, a copy of the complaints procedure and residents views of the home. The service users guide should not contain information that the home does not provide, for example the information given to the inspector states, “offering a range of activities which enables each residents to express themselves as a unique individual”. The home does have an activities programme; however activities are not carried out. Both residents and relatives have commented on the lack of activities and outings. This was also discussed at the last inspection on 31 May 2006 and a requirement made that a range of activities including trips and outings must be offered. Information provided also states that the home provides meals which enable residents as far and possible to decide for themselves where, when and with whom they consume food and drink of their choice. Again both residents and relatives have stated that there is no choice of meals, even though this is shown on the menus. Information included in the documents indicates that the home will, make all possible efforts to protect the residents from every sort of abuse and from the various possible abusers. On inspection of the staff training records staff had not completed training in the protection of vulnerable adults. The document states that the home will employ staff in sufficient number and with the relevant mix of staff to meet residents’ needs. This was not the case at the time of the inspection. Staff had not been suitably trained to carry out their role and there was no evidence of staff having completed an induction programme. The information states the home, “will observe recruitment policies and practices which both respect equal opportunities and protect residents safety and welfare. On inspection of four staff files, three had a written application form; one did not. Two had police checks from the Criminal Records Bureau (CRB), which had been transferred from another home and one member of staff, had a work permit but no CRB check or POVA First check. This is not permissible, therefore placing residents at risk. The Old Rectory DS0000005756.V322218.R01.S.doc Version 5.2 Page 12 The information provided also states that the home will install and operate effective quality assurance and a quality monitoring system; there was little evidence to indicate this system is in place. The last residents meeting was held on 26 November 2006 but there were large gaps between meetings with the previous meeting held on 3 March 2006. There is no evidence of relatives meetings having been carried out. Also, the home will offer residents with appropriate assistance in the management of their personal finances, however during inspection the manager was insistent that under no circumstances did they deal with or hold any residents personal finances. Each resident had a written contract. The inspector checked every contact for the residents living at the home. Contracts were seen to be the original ones issued at the time the resident had moved in to the home. Some did not contain up to date information, for example one had not been reviewed or amended since May 2002. The contracts made no reference to the any annual increases or changes. The contracts did not include the room to be occupied by the resident and any charges for additional services offered. Most of the contracts showed a different scale of fee charged. One contract stated that fee would be paid in cash. When the inspector asked for the receipts for the cash transaction, the owners said that this was a mistake and that no cash payment was ever received. The manager must review every contract ensuring that all the information is correct and the scale of fees charged is current and includes any additional charges made above the standard fee, such as hairdressing, newspapers, taxis and any top up fees charged. The inspector looked at two care plans. Both residents had lived at the home for several years. In both files there was no evidence to show that a pre admission assessment had been completed prior to admission. The manager must not admit any prospective resident into the home without completing a full assessment of the residents care needs ensuring that the home and staff can fully meet the needs of the individual. The Old Rectory DS0000005756.V322218.R01.S.doc Version 5.2 Page 13 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 need to be improved to provide staff with up to date clear information to ensure the needs of the residents can be fully met. The system for the administration and storage of medication is not satisfactory to ensure that medication is appropriately administered. EVIDENCE: Two care plans were chosen for inspection. The information contained is basic and does not provide staff with clear and concise information about each resident. The care plans appear to be a paper exercise rather than a working tool to assist staff in providing the right care to the individual. The care plans had been dated as being reviewed monthly as required. Brief social profiles were included in the files which helps provide staff with a background of the residents they are caring for. The Old Rectory DS0000005756.V322218.R01.S.doc Version 5.2 Page 14 Observation during the inspection showed that the personal care needs of the residents had been attended to. Most of the residents at this time appear to be quite independent and require the minimum of assistance. Residents were clean and well groomed. In one file the risk assessments require updating. There were gaps in both files with regard to the weighing of residents. Daily progress notes were recorded; again these were basic and not very informative. Residents have access to routine health care for example the doctor and district nurse. There is no evidence to show at that other outside agencies are contacted. It was noted that on most of the chairs in the lounge that small kylies (blanket that soak up urine) on them. This is unsightly and undignified and can highlight a resident that has a continence problem. If so many residents need to sat on kylies it is recommended that the manager seeks advice from the continence advisor to help rectify the situation. On inspection of two residents medication it was noted that one resident had two bottles of the same medicine open at one time. It was discussed with the manager that this was not good practice. Other medication was brought into the home in blister packs and on the day of the inspection the correct medication had been given and suitably recorded. The home holds a small amount of controlled drugs; these were suitably stored and recorded. The Old Rectory DS0000005756.V322218.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. The home does not provide a range of stimulating and fulfilling activities for residents to take part in. There is room for improvement to the meals served at the home to ensure that residents are offered more variety and choice. EVIDENCE: The range of activities is limited. Care staff are responsible for organising activities within the home. As there is only one member of care staff on duty, it is difficult for staff to plan and deliver any activities. Activities provided include bingo, scrabble, dominoes, puzzles, exercise and films. The recording of the activities needs improving to indicate who has taken part in which activity and when the activity took place. There is no evidence from August 06 to December 06 of trips and outings out of the home, apart from the Christmas meal at a local pub. The manager indicated that residents are not keen on going out, however residents went for the meal and one said how nice it was; and the manager told the inspector that some residents go out with their The Old Rectory DS0000005756.V322218.R01.S.doc Version 5.2 Page 16 families and some visit the hairdresser. Therefore it is evident that resident do wish to go out of the home. There was no evidence of shopping trips or local walks. Some of the activities recorded should not be classed as planned activities, for example listening to the radio, visitors to the home and watching the X factor. There is no evidence recorded that staff undertook any one-toone activities and no evidence of specialist activities for residents with memory difficulties. On the day of the inspection the planned activity should have been bingo, this did not happen, however it was noted that late afternoon that the member of staff sat with three residents playing dominoes. The manager announced to the residents in the lounge that during the afternoon the residents were going to write Christmas cards, this was done without consultation with the residents, this activity however did not take place. Whilst it was seen that some residents spent most of their time in their own rooms occupying themselves, other residents sat in the lounge spent a lot of time unoccupied and left to their own devices. The home has an open visiting policy. There are no restrictions on the time people visit. Evidence of this was highlighted in the visitor’s book where entries showed residents friends and relatives visiting at different times during the day and evening. One comment from a visitor to the home said that the care staff were “very good and kind and respectful, however as they are not from this country it is sometimes difficult for them to relate past experiences and local knowledge with the residents”. The choices residents made each day varied, dependent upon their mental frailty, but residents who were generally able chose what time they wanted to get up and when they wanted to retire, what clothes to wear, a limited choice of what they want to eat and whether or not to participate in any of the limited activities. It should be noted some residents have memory and communication difficulties so were unable to confirm they were able to exercise choice. The menus are planned over a four-week period. The manager advised that new menus were being introduced in the near future. The inspector observed breakfast being served at approximately 08.30. Only three residents dined on the dining room. All other residents were served breakfast in their rooms. Breakfast consists of fruit juice, choice of cereals, eggs, toast, tea or coffee. Residents should be asked if they would like a variation to this menu, which could include grapefruit, prunes, sausage, bacon and tomatoes, beans on toast. The same breakfast everyday must become very mundane. Lunch is the main meal of the day. While there is a menu board and individual menu stands on each table, there was nothing to indicate what was for lunch until the menu board was completed just before lunch was served. The menu on the board still did not reflect what was actually served. The Old Rectory DS0000005756.V322218.R01.S.doc Version 5.2 Page 17 Residents spoken with did not know what was for lunch indicating that they had not told or been given an alternative to the main meal. Lunch consisted of steak and kidney pie or chicken pie with potatoes, green beans and carrots. There should be a completely different choice offered, as the only difference between the two meals was the pie filling. A dessert of pears and custard was offered; again no choice was available. The manager must ensure that the menus accurately reflect what is served and what choices residents have been given and what people have actually had to eat. At lunch time the dining area was clean and the tables were suitably set. Cold drinks were provided with the meal, but no tea or coffee was offered after the meal. Residents were not rushed and the portions served were good. Residents spoken with said they had enjoyed their meal. The teatime meal is a lighter meal served about 5.00 pm. Both relatives and residents raised concerns with the inspector about the food served at teatimes. One comment made stated, “the teas are not good, there is no choice and if you do not like what it is served, hard luck, you get sat at a table and get what is put in front of you”. The manager must ensure that a substantial tea is served, and choices are offered. This could include omelette and salad, jacket potatoes with various filling, homemade soup and a various sandwiches. A record of what residents have eaten should be maintained. The manager confirmed that suppers were available and included toast, crumpets, scotch pancakes and drink of their choice, such as tea, coffee or a milk drink. The Old Rectory DS0000005756.V322218.R01.S.doc Version 5.2 Page 18 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. Residents and their relative cannot be assured that their complaints or concerns would be listened to, taken seriously and acted upon. Systems for protecting residents from abuse are not satisfactory therefore placing residents at risk. EVIDENCE: A complaints procedure was in place. It stated, “every complaint is acknowledge in five working days- investigations will take place within twenty eight days – all complaints will be responded to in writing – all oral complaints will be taken seriously”. Initially the complaints records were unavailable. The manager indicated there had been no formal complaints but said some residents brought up “small” issues. Eventually the complaints log was produced. There were no entries documented, pages had been ripped out and there was no format to work to for example the nature of the complaint/concern, the investigation or outcome. The manager is required to develop a better way of recording all complaint or concerns, as currently there is no written evidence that any complaints or concerns have been responded to. The Old Rectory DS0000005756.V322218.R01.S.doc Version 5.2 Page 19 The inspector has received a telephone call prior to the inspection. The caller raised concerns about the home being cold, the poor teatime menu served, the lack of activities, and that the owner children were left in the car in the car park unattended. This was discussed with the owners. The home has a vulnerable adults procedure, however a copy of the local authority procedure was not available. It was suggested the manager obtain a copy of this procedure, following which all staff should familiarise themselves with it. The homes procedure indicates that the manager will investigate any incidents of abuse. This needs to be amended to reflect local authority policies in that a strategy meeting may be held to decide what action needs to be taken. Also the manager’s way of dealing with this could potentially affect any investigation undertaken by the police. At the last inspection of 31 May 2006 there was no evidence of staff undertaking training in the protection of vulnerable adults. This has still not been undertaken therefore placing residents at risk of potential abuse. The Old Rectory DS0000005756.V322218.R01.S.doc Version 5.2 Page 20 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): 19,25 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The standard of the environment is satisfactory; some improvements are needed to make this a more homely and comfortable home for the residents living there. EVIDENCE: From a tour of the premises, it was seen that the home was clean and tidy. The dining room had new chairs and one bedroom had new laminate flooring. The lounge area needs attention, as the room is looking tired and in need of brightening up. The lounge curtains are not fitted properly and were hanging in parts off the rail. The Kylies must be removed off the chairs in the lounge, these are unsightly and do not respect the dignity of the residents. The The Old Rectory DS0000005756.V322218.R01.S.doc Version 5.2 Page 21 lighting in the lounge is poor, two bulbs needed replacing in the main light fitting. The lounge window is a large bay window, this requires attention as there was a draft blowing in through it and residents have to sit with their back to the window. The inspectors could feel the cold air blowing. The home was cold and not pleasant for residents to sit comfortably, some had blankets over their knees and round their shoulders. The inspectors monitored the temperature in the lounge with their thermometer as the homes thermometer appeared stuck on 70°f, over a period of time, at 08.00 am the heating was on and was registering at 70°f, another reading at 10.40 am showed the temperature had dropped to 68°f and the radiators were cooling down and by 11.40 am the reading was 64°f and the radiators were cold. The temperature in the dining before lunch was 62°f, only one of the two radiators was on. One of the inspectors was physically shivering in the dining room it was so cold. The inspector discussed this with the owners, whose response was, “someone must have turned the heating off”. The inspector told the owners that the home must be heated and the temperature maintained to no less than 70°f at all times. All of the bedrooms were inspected and were found to be clean and tidy, no odours were detected. Residents had personalised their rooms with their own belongings, photographs and mementoes. The bathrooms were clean and nicely decorated. It was noted that in one bathroom there was communal toiletries, shampoo and sponges. These items should not be in the bathroom for all the residents. Each resident should have their own toiletries stored in their own rooms and these should be taken into the bathroom when the residents are ready to bathe. It was noted that light bulbs were not working in the light fitting on the landing; this requires attention as it leaves the landing in semi darkness, which could be dangerous for the residents and staff and makes the landing look dismal. The outside of the home requires attention and painting especially the window frames which are in a poor state of repair. This was a requirement made at the last inspection on 31 May 2006 and to date no work has been carried. The laundry was inspected and was clean and tidy. The recent investment in a tumble dyer has been beneficial and clothes and bedding do not now need to be dried on the radiators around the home. Infection control procedures were satisfactory. The Old Rectory DS0000005756.V322218.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 poor. This judgement has been made using available evidence including a visit to this service. Staffing levels at the home and the skill mix and training is poor and needs to be addressed to ensure the needs of the residents are fully met. The recruitment of staff is not satisfactory and does not ensure the safety and protection of the residents living at the home. EVIDENCE: A written staff rota was maintained and a sample of the duty rosters examined. There is now only one waking member of staff on night duty and one member of staff sleeping in. These arrangements had not been brought to the attention of the CSCI prior to the inspection and must be subject to constant reviews. The home does employ any domestic staff. The owners do the cleaning and the registered provider does the cooking during the week. The inspector was informed that the care staff did the cooking at the weekend. The laundry is also done by the owners and by the care staff. During the day two staff provide cover from 08.00am until 08.00pm. The manager is counted into the staffing numbers with no evidence of her having any supernumery hours to undertake any management tasks. Staff ratios need to be reviewed The Old Rectory DS0000005756.V322218.R01.S.doc Version 5.2 Page 23 and at least two care staff need to be with the residents during the day and not caring out domestic tasks, such as cooking. This would enable staff to spend more quality time with residents and provide activities. Record keeping in the home need to be improved and as the manager is providing hands on care she needs to consider setting time aside for management tasks, such as planning training, staff supervision and introduction quality assurance system and improved care plan and contracts. The recruitment records for four staff were examined. Applications forms in three instances were seen, one member of staff had not completed an application form. Two references were seen on each file. CRB checks were had been undertaken, however two had been obtained from when staff worked at another care home and they had been transferred over and one oversees care worker only had a work permit and had not had a CRB check carried out. This is not acceptable and until all staff have a returned, current CRB and/ or POVA First check they must not work unsupervised at any time in the home. There was no evidence of any interview questions or notes kept on file. An up to date training matrix was not available at the time of the inspection, it was therefore difficult to assess how much training staff had received. In order for the manager to provide and monitor training when required a matrix should be kept an updated. Induction and training records had to be requested by the inspector a number of times. Eventually the manager produced in dribs and drabs some records. Records of four staff were examined. There was no evidence of staff having completed any induction training. Files looked at were untidy and difficult to ascertain what training had been completed by these staff. On one file the only training related to medication on 28 February 2006, another had completed health and safety training in 2004 and moving and handling in 2005 and continence awareness in 2004, optical awareness in 2004 and food hygiene in 2005. Most of the training had been completed when this member of staff was working at another care home. From the absence of any up to date records and with discussions with the manager it was evident that staff had not received the training they require. Both mandatory and specialist training require attention. An induction-training programme needs to be developed and as a minimum moving and handling, first aid, protection of vulnerable adults and food hygiene need to be provided. To evidence that staff are receiving training they need, a training record for each member of staff, which needs to be maintained and updated, and includes details and copies of certificates and dates of when courses had been undertaken and when refresher courses are due. Information provided by the manager states that 75 of staff have completed NVQ level 2 training and 11 staff hold a current first aid certificate. The Old Rectory DS0000005756.V322218.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): 31,33,35,36 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home is not being properly managed to ensure that the needs of the residents are being fully met and that staff are offered the support, leadership and training to successfully carry out their role. EVIDENCE: The manager is a qualified nurse and has achieved the NVQ level 4. The manager’s insistence to carry out domestic duties and a caring role has had a knock on effect on the management of the home. The management of the home must improve to ensure that standards are met and maintained, with particular regard given to recruitment of staff, staff training, induction of staff, The Old Rectory DS0000005756.V322218.R01.S.doc Version 5.2 Page 25 staff supervision and planned activities, a suitable quality assurance system in place and record keeping. Improvements are needed to ensure that a quality assurance system is in place. The last recorded residents meeting took place on the 26 November 2006 and prior to that on 3 March 2006. The inspector requested minutes of the last staff meeting and was told, “they were being typed”, the minutes of past staff meetings was requested and the inspector was shown the previous minutes dated 24 February 2006. There was evidence to show that residents/ relative satisfaction questionnaires had been sent, however the manager produce a copy of a questionnaire which she said was given to residents, but no completed questionnaires were available or evidence to demonstrate that the result of the questionnaires had been analyzed. When asked about the safe keeping of resident’s finances, the manager stated that the home does not deal with any resident’s monies. There is some discrepancy with this information, as a relative has stated that the manager, in the absence of a hairdresser attending the home starting to offer a hairdressing service and that manager had undertaken this role herself and that cash payment for this service was requested. The inspector requested the receipts of these transactions but was told by the manager that this did not happen and she only washed and dried the resident’s hair after they had had a bath. The pre-inspection questionnaire provided detailed the maintenance checks undertaken by external contractors. A number of which were checked on site and were found to be up to date and had valid certificate. A fire drill was undertaken on 10 November 2006. Staff training records were unclear as to whether fire safety training has been provided for staff. Staff supervision records were requested a number of times and the manager failed to produce suitable supervision records. This was a requirement made at the last inspection of 31 May 2006 that all care staff must receive formal supervision at least six times a year. This has not happened. The manager eventually produced two staff supervision records indicating that one member of staff had received supervision on 22 November 2005 and again on the 3 December 2006 and another 5 December 2006 no further dates available and an old record for another member of staff indicating that the last supervision session was 21 November 2005. The inspector had concerns that the CSCI has not been notified of any accidents, injuries or incidents that affect the well being of the residents. On inspection of the homes accident book at least five accidents had occurred from 5 October 2006 to 6 December 2006, which should have been reported to the CSCI by formal notification. The Old Rectory DS0000005756.V322218.R01.S.doc Version 5.2 Page 26 The Old Rectory DS0000005756.V322218.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 1 2 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 2 x x x x x 2 3 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 1 x 2 1 x 2 The Old Rectory DS0000005756.V322218.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 OP1 Regulation Schedule 1. Reg 4(1)(c ) Requirement The statement of purpose and the service user guide must be amended to provide prospective residents and their supporters with up to date, factual information about the home and the services it aims to provide. All residents must be provide with a up to date contact detailing the fee charged, any top up charges made and any additional charges made above the fee. All residents must have a full pre admission assessment prior to entering the home to ensure that the home can meet the individual’s needs and expectations. Resident’s care plans needs to be developed, so that they are a working tool to provide staff with clear and concise information about the care the residents require. All residents must be offered the health care services they require with regard to outside specialised agencies contacted as DS0000005756.V322218.R01.S.doc Timescale for action 28/02/07 2. OP2 5A (2) 28/02/07 3. OP3 14 31/01/07 4 OP7 15 28/02/07 5. OP8 12 28/02/07 The Old Rectory Version 5.2 Page 29 6. OP9 13 7. OP10 12 (4) (a) 8. OP12 16 9. OP14 16 10. OP16 22 11. OP18 13 12. OP19 23 required. The manager must ensure that all medication is appropriately dispensed, so residents receive this safely. 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. An activities programme must be made available and circulated to residents in a suitable format and include a range of trips and outings. (This is outstanding from the last inspection of 31 May 2006 with a timescale given of 28/07/06). Residents must be offered a choice of meals that which are available and preferences must be recorded. (This is outstanding from the last inspection of 31 May 2006 with a timescale given of 28/07/06). To allow scrutiny of complaints and how they are handled. The manager must ensure that all concerns and complaints are investigated and the outcomes recorded. (This is outstanding from the last inspection of 31 May 2006 with a timescale given of 28/07/06) In order that staff have the knowledge to detect and refer abuse, and in order to protect residents, all staff must be trained in the Protection of Vulnerable Adults. (This is outstanding from the last inspection of 31 May 2006 with a timescale given of 28/07/06). To ensure residents live in a well-maintained property that is presentable from the outside, DS0000005756.V322218.R01.S.doc 28/02/07 31/01/07 28/02/07 31/01/07 28/02/07 28/02/07 28/02/07 The Old Rectory Version 5.2 Page 30 13. OP25 23 (2) (p) 14. 15. OP25 OP27 23 (2) (p) 18 (1) (c) (i) 16. OP28 18 (1)(a) 17. OP29 19 18. OP30 18 (2) (b) 19. OP33 24 the outside of the home requires painting and maintenance. (This is outstanding from the last inspection of 31 May 2006 with a timescale given of 28/07/06). Residents must live in a home that is well lit; the manager must ensure that all parts of the home are suitable for the residents. Residents must live in a home that is warm and maintained to a suitable temperature at all times. 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. 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. To ensure residents are cared for by staff that have been properly vetted, the manager must not employ staff without a full Criminal Records Bureau check. The manager must ensure that staff undertake induction training and mandatory training suitable to their role so they are competent to care for the residents in the home. The views of those who use the service must be sought with an effective quality assurance system must be developed; with the results of surveys published and made available to service users, significant others and the CSCI. (This is outstanding DS0000005756.V322218.R01.S.doc 31/01/07 31/01/07 28/02/07 28/02/07 31/01/07 28/02/07 28/02/07 The Old Rectory Version 5.2 Page 31 20. OP36 18 21. OP38 37 from the inspection of 08/12/05 with a timescale given of 31/03/06 and from the inspection of 31/05/06 with timescale given on 28/07/06). 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. (This is an outstanding from the last inspection of 31/05/06 with a timescale given of 28/07/06). So that the CSCI is informed of serious incidents within the service, notifications of the occurrence of any serious injury to a person using the service must be made without delay. (This is outstanding from the last of inspection of 31/05/06 with a timescale given of 28/07/06. 28/02/07 31/01/07 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 OP18 Good Practice Recommendations A copy of the new local authority Protecting Vulnerable Adults procedure should be obtained. (Recommendation left at the last inspection of 31/05/06). The Old Rectory DS0000005756.V322218.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Bolton, Bury, Rochdale and Wigan Office Turton Suite Paragon Business Park Chorley New Road Horwich, Bolton BL6 6HG 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.V322218.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. 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