Inspection on 29/01/07 for The Old Rectory [Nunney]

This inspection was carried out on 29th January 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 [Nunney] 30/07/07

The Old Rectory [Nunney] 13/07/06

The Old Rectory [Nunney] 15/02/06

The Old Rectory [Nunney] 07/06/05

The Old Rectory [Nunney] 27/01/05

The Old Rectory [Nunney] 27/05/04

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 The Old Rectory High Street Nunney Frome Somerset BA11 4LZ Lead Inspector Sally Murphy Unannounced Inspection 29th January 2007 10:00 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 DS0000016007.V329106.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 DS0000016007.V329106.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Old Rectory Address High Street Nunney Frome Somerset BA11 4LZ 01373 836747 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 RONALD HILL MRS MARIAN CONSTANCE HILL MR RONALD HILL Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24) of places The Old Rectory DS0000016007.V329106.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13 July 2006 Brief Description of the Service: The Old Rectory is a large detached property located in the village of Nunney, approximately four miles from Frome. Service user accommodation is provided over two floors. There is a passenger lift, assisted bathrooms, and a call system available. The Old Rectory is registered with the Commission for Social Care Inspection to provide care for up to 24 service users over the age of 65 years. The proprietors are Mr and Mrs Hill. Mr Hill is also the Registered Manager. The home has been decorated and furnished to a high standard. The garden has been well maintained and is accessible to service users. The fees are £340 – £418 per week, with additional charges for hairdressing, private chiropody and toiletries. The Old Rectory DS0000016007.V329106.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection was unannounced and was carried out by Sally Murphy, Regulation Inspector and Sue Burn, Regulation Manager over one day. The previous key inspection was announced and was completed on 13th July 2006. A random inspection was completed on 5th December to follow up the requirements made at the previous inspection. It was found that only one of the requirements had been partly addressed, and that actions had not been taken to address the remaining requirements. Further areas of concern were also found during the visit on 5th December 2006, therefore this further key inspection has been by completed to inspect all areas of care practice within the home. During the course of this inspection, the Inspectors conducted a tour of the premises, observed care practice and talked with the Registered Manager, staff and service users. A number of care records including care plans, staff files and health and safety records were also examined. What the service does well: What has improved since the last inspection? Action has been taken to address one of the twelve requirements made at the random inspection on 5th December 2006, and the home now has a fax machine installed. At this inspection it was found that an opening date had been recorded for most prescribed creams. A trip was recently provided where five service users went to see the pantomime. The Old Rectory DS0000016007.V329106.R01.S.doc Version 5.2 Page 6 What they could do better: The Registered Manager must ensure that an assessment of need is completed prior to a service user moving in, to confirm that a placement is suitable, and that the home will be able to meet the service users. The Registered Manager should provide service users with a written statement of terms and conditions (contract), on moving into the home, so that service users are aware of their rights and responsibilities during their stay. Care plans must contain sufficient detail to enable staff to meet service users needs. Care plans must appropriately address service users diabetes, catheter care or mental health needs. A care plan must be developed for all service users, including those who have recently moved into the home, and those receiving respite care. Care plans must be updated appropriately following changes in service users needs. Where a healthcare need is identified, the care plan must include details of the actions being taken to address this. Service users must be weighed on a regular basis, and appropriate plans developed to meet their nutritional needs. Medication must be stored securely within service users rooms. A record must be been maintained of all medication received into the home. Controlled Drugs records must be appropriately maintained. Risk assessments must be completed in relation to service users wishing to self medicate. Medication requiring refrigeration must be stored securely within the fridge, and fridge temperatures recorded and monitored to ensure compliance with the temperature storage range. Staff must be provided with medication and diabetes training. Social care plans must be developed, so that activities may be provided to meet service users individual needs and interests. Service users should be advised of the meal being prepared each day, and be able to choose an alternative. Risk assessments must be completed and any necessary actions taken to ensure that service users are not at risk of injury from scalding from unguarded radiators. At the previous two inspections, a requirement was made for risk assessments to be completed in relation to the risk posed to service users from unrestricted window openings on the first floor. The home must review infection control practice within the home to ensure that the risk of cross infection is reduced. En suite bathrooms must be thoroughly cleaned to ensure that they remain hygienic. The Registered Person must ensure that all staff are provided with regular updates in manual handling and food hygiene training, and that an appropriate number of staff are provided with First Aid training. The Old Rectory DS0000016007.V329106.R01.S.doc Version 5.2 Page 7 For the protection of vulnerable adults, a POVA First check and two references must be completed prior to a member of staff commencing employment at the home. There are currently fifteen care staff employed at the home. An Enhanced CRB disclosure could not be found within the recruitment files for five staff members. The Registered Person must ensure that an enhanced CRB disclosure and two references are obtained for all staff, and that staff are provided with appropriate supervision until an enhanced CRB disclosure is received. A fire risk assessment must be completed, and staff must be provided with regular updates in fire safety training. The passenger lift must be tested every six months in accordance with LOLER regulations 1998, and a record maintained. All records relating to service users must be stored securely. Hazardous substances must be stored securely and not be accessible to service users. 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 DS0000016007.V329106.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 DS0000016007.V329106.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): 1,2, & 3. (Standard 6 does not apply). Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users are provided with appropriate information regarding the services and facilities offered at the home. The Registered Manager had not completed an assessment of need prior to two service users moving into the home, and was therefore unable to confirm that the home would be able to meet their needs. Service users had not been provided with a written contract outlining the terms and conditions of their stay. EVIDENCE: The Old Rectory has a Statement of Purpose and Service User Guide that provide details of the services and facilities offered at the home. The Old Rectory DS0000016007.V329106.R01.S.doc Version 5.2 Page 10 Care plans were examined for two service users who had recently moved into the home. These records did not contain any evidence of a pre-admission assessment being completed. The Registered Manager confirmed that a needs assessment had not been undertaken prior to either of the service users moving into the home. A requirement had also been made at the random inspection that took place on 5th December 2006 which stated that a comprehensive needs assessment must be completed before a service user moves in, to ensure that the placement will be suitable, and the home will be able to meet their needs. The Inspectors asked to examine the written terms of conditions for the two most recently admitted service users. The Registered Manager stated that a contract had not been given to them, and that contracts are often not given to service users until they have been at the home for several months. Two further service users spoken with during the inspection confirmed that they had not received a written contract, and were not aware of the terms and conditions of their stay. The Old Rectory DS0000016007.V329106.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 & 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The Registered Person has failed to develop appropriate plans of care to meet service users personal care and health needs. The storage, recording and administration of medication does not follow safe practice and may place service users at risk. Service users stated that they are treated with dignity and respect. EVIDENCE: During the course of the inspection eight care plans were examined in detail. The care plan for one service user had not been updated appropriately to reflect changes in their need. The score on dependency assessments had steadily increased, and indicated the areas in which their needs had changed, The Old Rectory DS0000016007.V329106.R01.S.doc Version 5.2 Page 12 but the plan of care providing instructions to staff had not been updated. The care plan stated that this service user required prompting to complete personal care tasks, but the daily records showed that they now needed full assistance. This service user had also suffered two falls between 26 – 29 January 2007, but the care plan had not been updated to reflect these. The last record of social activity for this service user who has memory problems was July 2006. The care plan for a further service user states that they can become verbally aggressive, but there was no plan in place to ensure that staff follow a consistent approach. Staff had maintained records on a behavioural chart, but it was not clear what action was being taken from this to address the service users needs. The care plan for this service user had not been signed or dated. The care plan states that this service user is ‘very confused’. There was no record of social activities for this service user. The daily records for a further service user indicates that they have a catheter, and reference is made to the leg bag being changed. However the care plan did not contain any further information regarding the catheter or plan of care that staff should provide. The night catheter bag was seen within this service users en suite bathroom, and was uncapped. The cap must be fitted to prevent the risk of infection. The care records did not stated how often the leg bag should be changed, or provide any information on when staff may need to contact the District Nursing Team or GP to provide catheter care. A falls risk assessment had been completed for this service user, but no risk assessment had been completed in relation to this service user managing their medication. A requirement was made at the previous two inspections regarding the completion of risk assessments for those service users who self medicate. The care plan was examined for a further service user who had recently been admitted to the home. The care plan did not contain a pre-admission assessment, initial assessment or any risk assessments. The only information recorded was the service users name, date of birth, next of kin and daily records. Within the daily records it states that the service user fell two days after arriving at the home, however this is not reflected within the care plan. A record within the General notes book states that the service user had ‘red and swollen legs’, but it was not clear from the records provided what action being taken to address this. The care plan for a further service user had not been completed in full, and had not been signed or dated. Within the personal care records there was no record of the service user receiving a bath between 9-23 January 2007 (13 days). The care record did not contain any care plan or risk assessments. This service user is diabetic, and no diabetes care plan had been recorded. There was no information advising the normal blood sugar levels for this service user, or guidance to staff on how often they should check the service The Old Rectory DS0000016007.V329106.R01.S.doc Version 5.2 Page 13 users blood, or when they should contact the District Nurse or GP. The care plan stated that the service user should not be resuscitated, but it was not clear where this information had come from. The Registered Manager should review any such entry in accordance with the Mental Capacity Act 2006. The care plan was examined for one service user who has insulin dependent diabetes. Following the previous inspection, further information had been provided regarding the dietary choices available to the service user. The care plan still did not contain information regarding the normal blood sugar levels for that service user, and did not include instructions to staff regarding the actions they should take in the event of levels either being above or below that range. The care plan was not sufficiently detailed to enable staff to fully meet this service users’ needs, and some of the guidance recorded, for example that the service user may exercise to reduce excess blood sugar levels, was not appropriate. One service user was receiving respite care. Their care record did not contain any care plans or risk assessments. The assessment states that the service user is diabetic and self-administers their medication. The home had no record of the medication that this service user is prescribed, or the quantity that they had brought into the home. The care plan seen a further service user had not been completed in full, and had not been signed or dated. Within the personal care records there was no evidence of the service user receiving a bath between 11/1/07 – 26/1 /07 (14 days), and further gap of over a month was noted during October / November 2006. This service user is also diabetic, and no care plan had been developed to instruct staff on how often they should test the service users blood sugar, what the normal range is for that individual is, or what they should do in the event of it being above or below these. A Community Psychiatric Nurse had also seen this service user and daily records stated that they had low mood, but there was no care plan to address this need. A record within the General Notes book for a further service user stated that one service user had ‘red dry skin patches on her back which are very itchy, can she be seen by a Doctor’. It is not clear what action was taken to address this, as the daily records and professional visitors do not evidence that a GP visit was requested. Service users had not been weighed on a regular basis. One service user had shown steady weight loss throughout last year, but had not been weighed since September 2006. A further service user had weighed 7 stone 5 lbs on 7/9/06 then 6stone 10lbs on 12/10/06, but had not been weighed again. Their care plan did not evidence any plan of action being taken to address this need. Nutritional risk assessments had not been completed. The Old Rectory DS0000016007.V329106.R01.S.doc Version 5.2 Page 14 Denture cleaning tablets were found within several service users en suite bathrooms. As stated in the previous two inspection reports, these may pose a risk of serious injury if swallowed; therefore a risk assessment must be completed in relation to these for each service user. During the course of the inspection, the Inspectors observed staff moving service users in wheelchairs without footplates. Failure to fit and use the footplates places service users at risk of injury and this practice must be addressed. Pressure relieving equipment had been provided for one service user. Pressure risk assessments had not been completed. The recording, administration and storage of medication were also examined during this inspection. Medication Administration Records (MAR charts) were examined. A record had not been maintained for some medication received into the home. An Immediate requirement was made on the day of inspection stating that a record must be maintained of all medication received. Where a medication is given on an ‘as required’ basis, the MAR chart did not indicate when this may be needed, and there were also no directions within the service users plan of how these medicines should be used. In some instances there was no record of the date when a medication commenced. Hand transcribed entries were sometimes not signed or dated, or recorded only one signature. For one service user the MAR chart states that there was none of that medication supplied that month, but signatures were recorded that the medication was given on 15/1/07 and 25/1/07. These had then been crossed through, so it was not possible to determine whether or not the service user had received this medication. A record had not been maintained of the receipt of a controlled drug into the home. On the day of the inspection an immediate requirement was issued stating that an investigation must be completed as to how this occurred, and necessary actions taken. Controlled drugs records did not include two staff signatures. There was no record of the administration of prescribed creams. External and internal medication should be stored separately. Most creams had an opening date recorded. At the random inspection completed on 5th December 2006 a medicine pot containing 21 tablets was found within one service users room. As these medications were not in their original packaging it was not possible to identify them. It was required that the home seek to identify the medication and The Old Rectory DS0000016007.V329106.R01.S.doc Version 5.2 Page 15 investigate how such a large quantity of medication accumulated without staff being aware. The home was also required to provide a plan of the actions they will take to prevent this from happening in the future. The Inspectors were informed by the Registered Manager that this medication was iron tablets that had been purchased by the service users relative. This explanation does not concur with the size, colour or information imprinted on the medication. There were no records to evidence that an investigation had taken place, or an appropriate plan developed to prevent this re-occurring. Risk assessments had not been completed in relation to those service users who wish to self medicate. There was no record of the date or quantity of medication given to service users, and no evidence of medication being monitored to ensure that it was being taken appropriately. An immediate requirement was made stating that risk assessments must be completed for all service users who wish to self medicate, and that secure storage facilities must be provided. The key to medication cupboards must be kept with the senior member of staff at all times during their shift. The insulin pen for one service user had not been stored securely and was accessible within their bedroom. This poses a significant risk to other service users and visitors to the home. The insulin pen and blood testing equipment used by this service user were heavily stained with blood. These require thorough cleaning to ensure that they remain hygienic. This service user has reduced dexterity in their hands, and there was no evidence that staff had observed them obtaining a blood sample to ensure that they remained able to do this without any assistance. There was no sharps box accessible for this service user. Pholcodine cough medicine was also available within their room. The Registered Manager must ensure that secure storage is provided. The further stocks of insulin had been stored in the fridge. They must also be stored securely. The fridge temperature had not been monitored or recorded. On the day of inspection an immediate requirement was made that the fridge temperature must be recorded daily and any action taken, as it important that insulin is stored between 2-8 C to ensure that it can be used. Inhalers were also found to be accessible within service users rooms. A requirement was made at the two previous inspections stating that medication must be stored securely. Medication is placed in plastic containers to complete the drugs round. The carer took the medicines from the locked cupboard, and left them in the containers in the kitchen whilst the meal was being served. The carer would be unable to lock the medication away securely, should they need to respond to an emergency. The Old Rectory DS0000016007.V329106.R01.S.doc Version 5.2 Page 16 A large number of dressings were found within a drawer in the office that expired in 2002, and 2005. This drawer also contained saline spray and Instillagel and had not been locked. There was no evidence that staff had received training on diabetes, or how to test or monitor blood sugar levels. The Old Rectory DS0000016007.V329106.R01.S.doc Version 5.2 Page 17 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 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a limited range of activities provided. Service users are not able to exercise choice regarding the meals that they receive. EVIDENCE: Service users advised that organised activities take place twice a week, when an entertainer visits the home and provides a range of activities. Mr Hill had also recently taken five service users to see the pantomime. Within some of the care plans examined there was no record of social activities at all, or none for several months. The home must develop social needs plans so that activities may be provided to meet their individual needs and interests. Service users are able to spend time within communal area, or their own room, as they prefer, and are able to access the garden at the rear of the property. Visitors are welcomed at the home. A church service takes place within the home each month. The Old Rectory DS0000016007.V329106.R01.S.doc Version 5.2 Page 18 One service user seen during the inspection did not have their call bell accessible and would not have been able to summon staff if required. Meals are prepared on the premises. Service users are not advised of what is being prepared, or offered a choice of menu. Lunch was observed. Service users were not told what the meal was when it was given to them. Service users were not consulted regarding the size of portion, or offered a choice of which vegetables they would like. Several of the service users spoken with stated that they would like a choice of meals. Comments were also received from some service users that portions sizes were not always adequate. Service users said that meals were well prepared. The Registered Manager advised that there are plans to review the menu. The home is able to cater for specialist diets. The Old Rectory DS0000016007.V329106.R01.S.doc Version 5.2 Page 19 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 & 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home has an appropriate complaints procedure. The registered person has potentially placed service users at risk, through failure to complete a POVA First check prior to staff commencing work at the home. EVIDENCE: A copy of the home’s complaints procedure is displayed in the hallway. This includes the contact details of CSCI. There have been no complaints received by the home or CSCI since the last inspection. The home has an appropriate whistle blowing policy. The registered person had failed to obtain a POVA First check or enhanced CRB disclosure prior to staff members commencing work at the home. The POVA First check matches the identity of the applicant against the list of people who are unsuitable to work with vulnerable adults. Through failure to complete this check, the home has potentially placed service users at risk of being cared for by people who are not suitable to work within a care home. The Old Rectory DS0000016007.V329106.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): 19,20,21,22,23,24,25, & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users live in a comfortable environment. Further action must be taken to ensure the safety of service users. There is sufficient communal space and bathing facilities to meet service users’ needs. The home was generally found to have a good standard of cleanliness. Infection control practice is not adequate and must be reviewed. EVIDENCE: The Old Rectory DS0000016007.V329106.R01.S.doc Version 5.2 Page 21 Service user accommodation is provided on the ground and first floor. All service user rooms have en suite facilities, or sole use of a bathroom nearby. There are two assisted bathrooms, a passenger lift and call system available to service users. Communal space comprises of a large lounge, large dining room, and quiet room. Service user rooms have been personalised to reflect individual tastes and preferences. The home has been decorated and furnished to a good standard. Radiator guards have been fitted in many parts of the home. These are still required in room 12 where the radiator is next to the service users bed, and near the toilets on the ground floor. Electrical wiring was accessible and needs boxing in near room 10. The carpet has torn in the hallway near to the kitchen and requires repair to ensure that it does not pose a trip hazard to staff and service users. Hot water outlet temperatures were tested and found to be within appropriate limits. The windows fitted are of the ‘turn and tilt’ design. This means that they could be opened fully, and may pose a risk of service users falling from an upper floor. This was discussed with the Registered Manager at the last key inspection in July 2006 when he advised that where a service user is considered to be at risk, brackets would be fitted to ensure that the window cannot be fully opened. It was required at that inspection that a risk assessment must be completed, and regularly reviewed for all service users occupying rooms on the first floor where their window may be opened fully. No evidence was found at this inspection that the risk assessments had been completed, or any actions taken to restrict the window openings. The home has emergency lighting fitted. The Registered Manager was not able to locate any records of this being tested on a monthly basis. The home is generally maintained to a good standard of cleanliness, however many of the en suite toilets, and particularly the grab rails around toilets require further cleaning to ensure that they remain hygienic. Some denture storage pots seen within service users rooms required thorough cleaning. Hand washing facilities consisting of liquid soap and paper towels had been provided in some parts of the home. A towel dispenser is required within the bathrooms to store paper towels. Paper towels had been stored within plastic containers in service users rooms. This means that staff will have to remove the lid of the container with soiled hands and therefore risk spread of infection to the next person that will also need to remove this lid to access the paper towels. Soiled pads were also seen within open bins in service users rooms. To prevent the risk of cross infection, foot operated flip top bins must be provided in bathrooms, toilets, and service users en suite bathrooms. One service user room was malodorous. The bath chair required thoroughly cleaning. The wood had split in the toilet seat in one service user en suite The Old Rectory DS0000016007.V329106.R01.S.doc Version 5.2 Page 22 bathroom and requires replacement. During the inspection one member of staff was observed carrying an incontinence pad from one service user room to another before disposing of this, and undertaking a number of tasks wearing the same pair of gloves, therefore potentially spreading infection throughout the home. The Old Rectory DS0000016007.V329106.R01.S.doc Version 5.2 Page 23 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, & 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staff are not provided with regular updates in mandatory training. The home has not operated a robust recruitment procedure. EVIDENCE: Duty rotas are maintained. One the day of the inspection there were two Care Assistants, one Cook, one Domestic Assistant and a Bath Assistant on duty. A staff training matrix is displayed on the notice board in the office. This recorded that no staff have received manual handling, food hygiene or basic first aid training. Two staff had completed some dementia training, two staff had completed some training on diet and nutrition, one person had done some risk assessment training and one person had completed training on coping with aggression. The Registered Manager confirmed that there was no further records relating to staff training. Staff spoken with during the inspection confirmed that they had not undertaken manual handling training within the last six months. Certificates found within some individual staff files indicated that manual handling training had not been provided since March 2005. The Old Rectory DS0000016007.V329106.R01.S.doc Version 5.2 Page 24 Currently only one member of staff has completed the NVQ level 2 qualification in direct care. The home should continue to support and encourage staff in obtaining this qualification. The National Minimum Standards for Older People states that at least 50 of the care staff employed should have completed this qualification. All staff recruitment files were examined. It was found that out of the fifteen care staff currently employed at the home, that five did not have evidence of a POVA First check of Enhanced CRB disclosure being obtained. The CRB application form for one of these staff members was still within the file. One of the five staff that did not have an enhanced CRB recorded was a carer who works alone at night. One person had not completed an application form and no references had been obtained regarding them, and the employment history had not been completed fully for a further staff member. The staff file was examined for a staff member who was about to start work at the home. There was no evidence of a POVA First check or enhanced CRB being obtained. One verbal reference had been received, but the record did not state whom this was from. The CRB for one staff member recorded a number of convictions, but their file did not contain any evidence of these being discussed with them or risk assessments being completed. Induction checklist had been completed for some staff members but had not been dated. Staff files were also examined for three staff that had ceased employment at the home. Two of these did not contain any references, POVA First check, or CRB disclosure, and the third contained an enhanced CRB from their previous employer. The Old Rectory DS0000016007.V329106.R01.S.doc Version 5.2 Page 25 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): 31,32,33,34,35,36,37 & 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Management of the home is poor. A number of areas of procedure and practice require review to ensure that service users receive appropriate care and are not placed at risk. Fire safety and equipment servicing records have not been appropriately maintained. The Registered Manager has not taken appropriate actions to ensure the health and safety of service users. EVIDENCE: The Old Rectory DS0000016007.V329106.R01.S.doc Version 5.2 Page 26 The Registered Manager and Provider is Mr Ronald Hill. Until recently he has been assisted by a Care Manager in the day-to-day running of the home. As previously described in this report, the provision of care plans, management of medication, staff recruitment, training and hygiene practices require significant improvement to ensure that the home is able to fully meet service users needs. The home does not have any formal systems for obtaining feedback from service users on the service provided. Service users stated that they would feel able to raise any issues of concern. The home will keep money securely for any service users that wish them to. Records are maintained of all transactions involving service users finances. Two monies were checked and tallied with records kept. It is recommended that for the protection of both staff and service users that these records are supported by receipts. The home displays appropriate Employers Liability insurance. Since the last inspection the home has had a fax machine installed. The Registered Manager confirmed that staff are not provided with regular supervision. Care plans are stored securely. A box of Medication Administration Records (MAR charts) had been stored in a cardboard within the Quiet Lounge, and were accessible to service users and visitors. These must be removed and stored appropriately. Fire safety records were examined. The Registered Manager could not locate a record of the fire system being serviced within the last twelve months, or of the fire system being tested each week, or the emergency lighting being tested on a monthly basis. An immediate requirement was issued stating that the fire system and emergency lighting must be tested and a record of this forwarded to CSCI. Following the inspection records were sent to CSCI confirming that the fire system had been serviced on 1/12/06, and records were provided of the fire system being tested on a weekly basis, and emergency lighting each month. On the servicing record for the fire system, it stated that four emergency lights were not working. The registered person must provide confirmation that appropriate action has been taken to address this. The fire risk assessment had been started but not completed. A Dorguard near the Quiet lounge had been wedged open. Records could not been found of staff receiving updates in fire safety training. These matters potentially place service users at risk of harm. CSCI will contact Somerset Fire and Rescue Service to request that a Fire Officer visits the home to monitor compliance with the relevant legislation. The Old Rectory DS0000016007.V329106.R01.S.doc Version 5.2 Page 27 The Registered Manager was unable to provide evidence that the passenger lift had been serviced within the last six months, as required under LOLER Regulations 1988. The last certificate found included three recommendations. It was not possible to determine whether these had been implemented. Fridge temperatures had not been recorded or monitored appropriately. There was no record from 28/12/06 – 4/1/07. The temperature for one fridge was recorded as –20 C on 23/1/07 and 29/1/07. A portable heater was found in room 1. This had not been guarded and also posed a trip hazard. The cupboard containing cleaning fluids, which opens onto the residents lounge was not locked and was accessible to service users. Accident records had been maintained. Accident records need to be stored in the individual service users or staff members files, in order to comply with the Data Protection Act 1998. One service user had suffered four accidents, but there was no evidence of accidents being audited, so that preventative measures may be taken. The Old Rectory DS0000016007.V329106.R01.S.doc Version 5.2 Page 28 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 3 2 1 x X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 3 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 3 3 3 3 3 1 1 STAFFING Standard No Score 27 3 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 2 2 3 2 1 2 1 The Old Rectory DS0000016007.V329106.R01.S.doc Version 5.2 Page 29 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 (s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14 (1) Requirement The registered person shall not provide accommodation to a service user unless the needs of the service user have been assessed by a suitably trained person. This relates to the need to ensure that a comprehensive needs assessment is completed. (Previous timescale of 12/01/07 not met). 2. OP7 15 (2b) Care plans must be updated appropriately to reflect changes in service users needs. All entries in care records must be signed and dated. 3. OP8 15 (1) An appropriate plan of care must be developed: • for service users who can display challenging behaviour to ensure that staff are able to respond in a consistent manner. to ensure that staff are Version 5.2 Page 30 Timescale for action 23/02/07 02/03/07 16/03/07 • The Old Rectory DS0000016007.V329106.R01.S.doc aware of how to meet service users mental health needs. 4. OP8 17 (1) & schedule 3 When a service user has suffered 16/03/07 a fall, the care plan must be updated. A falls risk assessment should be completed and any necessary action taken to reduce the risk of further injury. An appropriate care plan must be developed where a service user has catheter care needs. This must provide staff with sufficient information regarding the actions that they must take. The night bag must have a cap fitted to prevent risk of infection. 6. OP8 15 (1) The registered person shall 16/03/07 prepare a written plan outlining how a service user’s needs are to be met. This relates to the need to ensure that a comprehensive diabetic care plan is developed for any service user who has diabetes. (Previous timescale of 12/01/07 not met). 7. OP8 13 (1b) The blood testing equipment used by one service user was heavily stained with blood. The Registered person must ensure that an assessment is completed by an appropriately trained person to ensure that this service user continues to be able to complete this task unaided. When a healthcare need is identified for a service user, this must be recorded within their care plan, rather than a General DS0000016007.V329106.R01.S.doc 5. OP8 17 (1) & schedule 3 16/03/07 16/03/07 8. OP8 13 (1b) 23/02/07 The Old Rectory Version 5.2 Page 31 notes book, and a record must be maintained of the actions taken to address this need. 9. OP8 17 (1) & schedule 3 When ‘do not resuscitate’ is recorded in a care plan, a record must be maintained of where this information has come from. This was found within one care plan, and the Registered Manager must review any such entries to ensure that they comply with the Mental Capacity Act 2006. 10. OP8 17 (1) & schedule 3 Service users must be weighed regularly and where appropriate, care plans must be developed to address service users nutritional needs. Risk assessments must be completed in relation to the storage of denture cleaning tablets, and any necessary actions taken. (Previous timescale of 25/08/06 not met). 12. OP8 13 (4b) Footplates must be used on wheelchairs, to prevent risk of injury to service users, unless a risk assessment identifies otherwise. 23/02/07 16/03/07 16/03/07 11. OP8 13 (4) 16/03/07 13. OP9 13(2) The registered person shall make 05/02/07 arrangements for the recording, safekeeping and safe administration of medicines in the care home. This relates to the need to ensure that:A risk assessment is completed in relation to any service user self-administering their medication, and that safe The Old Rectory DS0000016007.V329106.R01.S.doc Version 5.2 Page 32 storage is provided for medication within service users rooms. (Previous timescale of 25/08/06 not met). 14. OP9 13 (2) The registered person shall make 23/02/07 arrangements for the recording, safekeeping and safe administration of medication in the care home. It is required that the home seek to identify the medication that was found at the random inspection completed on 5th December 2006, and investigate how such a large quantity of medication accumulated without staff being aware. The home must also provide a plan of the actions that will be taken to prevent this from happening in the future. (Previous timescale of 12/01/07 not met). 15. OP9 13 (2) A record must be maintained of all medication received into the home. When medication is prescribed on an ‘as required’ basis, guidance must be provided to staff of the condition or symptoms that this is to treat. An investigation must be completed into why a controlled drug had not been recorded as received into the home, and necessary actions must be taken to rectify this. A record must be maintained for DS0000016007.V329106.R01.S.doc 05/02/07 16. OP9 13 (2) 23/02/07 17. OP9 13 (2) 05/02/07 18.. OP9 13 (2) 23/02/07 Page 33 The Old Rectory Version 5.2 the administration of prescribed creams. 19. OP9 13 (2) The stock of insulin must be stored securely within the fridge. The fridge temperature must be monitored and recorded daily to ensure that insulin is stored between 2-8 C. 20. OP9 13 (2) The Registered Person must 13/04/07 review the storage arrangements for medication during drug rounds, to ensure that staff are able to store medication securely, should they need to respond in an emergency. The insulin pen and blood testing equipment must be thoroughly cleaned to ensure that they remain hygienic. A sharps box must be provided for this service users use. 22. OP9 13 (2) The key to the medication cabinet must be kept with the senior member of staff at all times. Those dressings that are out of date, must be removed from the drawer in the office. Saline spray and Instillagel must be stored securely. 24. OP12 16 (2n) The registered person must ensure that social needs plans are developed so that activities are provided to meet service users individual needs and interests. Service users must be able to access their call bell at all times, DS0000016007.V329106.R01.S.doc 05/02/07 21. OP9 13 (4c) 23/02/07 23/02/07 23. OP9 13 (2) 23/02/07 31/03/07 25. OP14 12 (2) 23/02/07 Page 34 The Old Rectory Version 5.2 to summon staff assistance. 26. OP19 13 (4a) Electrical wiring is accessible and needs boxing in near room 10. The carpet has torn in the hallway near the kitchen. Appropriate action must be taken to ensure that it does not pose a trip hazard to staff and service users. 27. OP25 13 (4a) Radiators situated next to the service users bed in room 12, and near the toilets on the ground floor have not been guarded. Unguarded radiators pose a potential risk of injury through scalding to service users. A risk assessment must be completed in relation to these unguarded radiators and any appropriate action taken. A risk assessment must be completed, and regularly reviewed for all service users occupying rooms on the first floor where their window may be opened fully, and any necessary actions taken. (Previous timescale of 25/08/06 not met). 29. OP26 16 (2j) En suite bathrooms must be thoroughly cleaned to ensure that they remain hygienic. Appropriate action must be taken to address the malodour within one service users’ room. Denture cleaning pots must be kept clean and hygienic. 30. OP26 13 (3) The registered person shall make 23/02/07 DS0000016007.V329106.R01.S.doc Version 5.2 Page 35 09/03/07 31/03/07 28. OP25 13 (4a) 16/03/07 23/02/07 The Old Rectory suitable arrangements to prevent the spread of infection. This relates to need to ensure that appropriate hand washing facilities are available in all areas of the home where staff may provide assistance with personal care and in staff areas. (Previous timescale of 12/01/07 not met). 31. OP26 13 (3) Hygiene practices must be reviewed to ensure staff are aware of the actions to be taken to reduce the risk of cross infection within the home. As part of this review the registered person must ensure that: - paper towels are readily accessible - foot operated flip top bins are provided in bathrooms, toilets, and en suite bathrooms. - the bath chair is thoroughly cleaned. - the toilet seat that had split is replaced. 32. OP29 19 & Schedule 2 For the protection of vulnerable adults, a POVA First check must be received before a staff member begins work at the home, and appropriate supervision must be provided until the enhanced CRB disclosure is received. (Previous timescale not met 18/08/06). 33. OP29 19 & The registered person must DS0000016007.V329106.R01.S.doc 09/03/07 23/02/07 05/02/07 Version 5.2 Page 36 The Old Rectory schedule 2 ensure that an enhanced CRB disclosure and two references are obtained for all care staff currently working at the home. The registered person must ensure that staff receive appropriate supervision until the enhanced CRB is received. 34. OP29 19 & schedule 2 Where a CRB disclosure records 09/03/07 an offence, the registered person must ensure that this is fully discussed with the staff member and that an appropriate record is maintained. A risk assessment should be completed in relation to the tasks that they will undertake within the home. 35. OP30 13 (4) & 13(5) Staff must be provided with training in manual handling and food hygiene. The registered person must ensure that an appropriate number of staff have received first aid training. 23/03/07 36 OP30 18 (1c) Staff must be provided with the appropriate training for the work that they perform. This will include training on: care planning, medication, diabetes, infection control, and abuse awareness. The registered person must submit a training plan with appropriate timescales by 31/3/07. 31/08/07 37. OP30 18 (1) [c] Newly employed staff must be provided with Induction training, and a record, which is signed and dated must be maintained. DS0000016007.V329106.R01.S.doc 23/02/07 The Old Rectory Version 5.2 Page 37 38. OP37 17 (1b) MAR charts must be removed from the Quiet lounge, and be stored securely in accordance with the Data Protection Act 1998. The fire risk assessment must be completed. The Dorguard near the Quiet lounge must not be wedged open. Four emergency lights were not working when the fire system was serviced on 1/12/06. The registered person must provide confirmation that these have been repaired and are now working. 23/02/07 39. OP38 23 (4 a & c) 23/03/07 40. OP38 23 (4d) Staff must be provided with regular updates in fire safety training. The passenger lift must be tested every six months in accordance with LOLER regulations 1998, and an appropriate record maintained, 23/03/07 41. OP38 13 (4a) 23/03/07 42. OP38 13 (4a) Appropriate action must be 23/02/07 taken to ensure that the portable heater in room 1, does not pose a risk of scalding to service users, and is not a trip hazard. The registered person shall ensure that all parts of the home to which service users have access are free from hazards to their safety. This relates to the need to ensure that hazardous substances must be stored securely and not be accessible to service users. DS0000016007.V329106.R01.S.doc 43. OP38 13 (4a) 23/02/07 The Old Rectory Version 5.2 Page 38 (Previous timescale of 12/01/07 not met). 44. OP38 17 (1) Accident records must be stored in accordance with the Data Protection Act 1998. Accidents must be regularly audited to ensure that preventative measures may be taken. 09/03/07 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. 2. Refer to Standard OP3 OP8 Good Practice Recommendations Service users should be provided with a written statement of terms and conditions, on moving into the home. It is recommended that a pressure risk and nutritional risk assessment is completed for each service user on admission to the home, and reviewed on a regular basis. It is recommended that the reason is recorded when medications are returned to the pharmacy. All hand transcribed entries must include the quantity of medication, date and staff signature. This entry should be checked and signed by a second staff member to confirm that it is correct. All records relating to Controlled Drugs should include two staff signatures. Internal and external creams should be stored separately. At present not all of the activities provided are recorded. It is recommended that staff maintain individual activities records are maintained for each service user, to ensure that all have the opportunity to meet their social needs. DS0000016007.V329106.R01.S.doc Version 5.2 Page 39 3. 4. OP9 OP9 5. 6. 7. OP9 OP9 OP12 The Old Rectory 8. OP15 Service users should be made aware of the meal that is being prepared each day, and be able to choose an alternative. Emergency lighting should be tested on a monthly basis and an appropriate record maintained, The home must continue to support and encourage staff in obtaining this qualification. The National Minimum Standards for Older People state that at least 50 of the care staff employed should have completed this qualification. A full employment history should be obtained from staff members to ensure that any gaps in employment can be fully investigated. The home should consider establishing systems such as residents meetings or service user surveys to seek feedback on the service provided. It is recommended that receipts are maintained to support records relating to service users finances. Staff should receive supervision at last six times each year. 9. 10. OP25 OP28 11. OP29 12. OP33 13. 14. OP35 OP36 The Old Rectory DS0000016007.V329106.R01.S.doc Version 5.2 Page 40 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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. 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