Inspection on 06/01/09 for The Old Vicarage Residential Home

This inspection was carried out on 6th January 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 31 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Old Vicarage Residential Home 22/12/08

The Old Vicarage Residential Home 31/07/08

The Old Vicarage Residential Home 26/09/06

The Old Vicarage Residential Home 25/10/05

The Old Vicarage Residential Home 12/05/05

The Old Vicarage Residential Home 26/11/04

The Old Vicarage Residential Home 13/05/04

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Old Vicarage Residential Home Silver Street Whitwick Coalville Leicestershire LE67 5EW     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Lesley Allison-White     Date: 0 8 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 41 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 41 Information about the care home Name of care home: Address: The Old Vicarage Residential Home Silver Street Whitwick Coalville Leicestershire LE67 5EW 01530831802 F/P01530831802 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: The Old Vicarage Residential Home Ltd care home 19 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: To specify the minimum age: No person under 18 years of age who falls within the categories OP, PD or DE may be admitted to the Old Vicarage Residential Home. Date of last inspection Brief description of the care home The Old Vicarage is a residential home for older people situated in the heart of the village of Whitwick. The home is a Grade II listed building of historic interest. It has 19 single bedrooms, most of which have en-suite facilities, two lounges, a small reading room, and a dining room. To the rear of the home is a large secluded garden. There is a car park. Fees range from £334.00 to £396.00 per week. An old copy of the Statement of Purpose and Service Users Guide is available at the entrance to the home (these provide information on how the home is organised and what services they 19 0 19 Over 65 0 19 0 Care Homes for Older People Page 4 of 41 Brief description of the care home provide). A current Employers Liability certificate of insurance is displayed in the hallway and a copy of the inspection report should also be available on request. Care Homes for Older People Page 5 of 41 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This is an overview of what the inspector found during the inspection The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. A random inspection took place before Christmas and a strategy meeting that included other services and the owners prompted this key inspection. This key inspection was competed over two days by two inspectors. On the first day of inspection there were fifteen people living at the care home. On the second day of inspection there were also fifteen people plus one person for day care. There were no people in hospital. Care Homes for Older People Page 6 of 41 Discussions were held with individuals living at the home, visiting relatives of the people who live at the home and staff. The registered persons (owners) and a management consultancy team working with the owners facilitated the inspection. The primary method of inspection used was case tracking. This involved speaking with individuals who use the service provided, looking at six care plans and observing care practices. A number of requirements were made. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 41 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 41 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standard 3 and Standard 6 Staff works in isolation without referring to any care plan, that will meet the needs of the individuals in their care. Evidence: The Statement of Purpose and Service User Guide had still not been completed but due to the Registered Manager having been unwell recently this requirement will be repeated and the owners are aware that they must forward this within two weeks of this inspection date. Previous assessments of the six people case tracked where and if they existed, no longer satisfied their current and continuing needs. The impact of this on their current care needs and a lack of assessment details has now become apparent. This has Care Homes for Older People Page 10 of 41 Evidence: resulted in inadequate care for the individuals care needs. Advice from specialist services is not obtained prior to accepting individuals with specialist needs. This results in the staff not having the knowledge or specialist skills needed to cope with such individuals or not updating their skills sufficiently to be able to cope with the changing needs of the individuals that they care for. This is explained more fully under Health and Personal care. Good quality training is not provided to enable staff to develop and be aware of current good practice. Intermediate care is not offered at this care home although day care is offered. One person was seen attending day care. Care Homes for Older People Page 11 of 41 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standard 7, Standard 8, Standard 9 and Standard 10 Staff do not record health care issues within individual care plans and there is little evidence of regular health monitoring. Few staff have the experience or training to meet the health needs of individuals living at the home and staff are not aware of where to seek advice. In this way individuals are unintentionally put at risk. Evidence: Six people were case tracked. In many cases information about them was absent or insufficient to provide for the individuals care needs. A new care assessment was seen. It still did not contain important details. One individual had a sore mouth. It stated that they had problems with chewing and no swallowing difficulties. There was no mention of staff requesting a doctor to visit, to diagnose the cause of the sore mouth or any treatments such as a mouth wash to help with this persons oral hygiene. Fluid balance charts were not always dated or signed. This gave them limited value in terms Care Homes for Older People Page 12 of 41 Evidence: of tracking that care needs were being met. Another person had a nutritional tool and stated that there was no change to their needs. Daily records lacked detail about the persons daily intake but stated that they had a poor appetite and needed encouragement to eat and drink. This persons weight was recorded in November 2008. No other entires of a monitoring of weight for this person was seen. In early January 2009 an entry stated that they took breakfast and dinner well but it failed to say that the person needed significant assistance and encouragement to do so during meal times. A moving and handling assessment was in place it was unclear from the assessment the assistance required. This person also needed encouragement with transfers. There were no details as to how this should be done. This shows a lack of training to complete charts and a lack of supervision in the work place by senior staff or managers. Another person living at the home was admitted to hospital and they were in hospital for a number of days. A regulation 37 form was not sent into the Commission for Social Care Inspection. The registered person has a legal commitment to do so. Two people at the care home had a number of pressure areas. They were moved to another care home as the staff did not have the skills required to care for them. We spoke with a visiting healthcare professional who said that staff had noted that one person had a red mark on their back however the healthcare professional said that they were unclear as to whether the staff had received any pressure area care training. However the staff had started to identify people who needed continence assessments and the health care professional was visiting twice a week to make these assessments. Moving and handling practice was witnessed by a social worker on the day of inspection who witnessed staff using a drag lift and the individual living at the home also said that she had been asked to walk up the four steps. Neither the care plan or the risk assessment for this person had not been updated from 2007 and so could not evidence where this persons needs had changed. However daily records on this person had improved. Privacy and dignity needs of an individual with dementia was not met as the staff had used a stairgate to contain them. This individual was not allowed to wander around the home. The room did not have a door attached to it at the time. Another person was admitted who could put others at risk. They had behavioural problems. Although the staff knew that this person was un predictable and had to have their meals first this person was left in their room and became increasingly annoyed Care Homes for Older People Page 13 of 41 Evidence: when anyone approached them that did not have their food at the appropriate times. The inspector also felt that this person had a problem with black staff and felt that as part of a risk assessment visitors or agency staff should be made aware of this when visiting this person. The consultancy management team had recognized that the medicine trolley would be better placed in a lockable area of the home giving the medication trolley better security. Medications was checked. Medications need by three individuals with nutritional supplements were not always ordered or not given by the staff. The consultancy team who had spent some time observing regular practices of the senior care staff giving medicines and found that their practice was not up to an appropriate standard and initially failed staff and did not allow staff to give medicines without further assessments and training. The providers of the medicines to the home have been changed and the new medicine providers have agreed to give staff medication training at regular intervals. On the first day of the inspection visit an agency staff member was instructed to give out medication. We observed her ask the wrong person if they wanted pain relief medication. We stopped the person from continuing to administer medication as they said they were un sure who people were because the chart linking photographs with names was unclear. The competent staff then assisted the agency staff member to complete the medicine round. The consultants have subsequently arranged for a qualified nurse to administer medication when no competent member of staff is available. A prescribed cream for someone living at the home was seen in another person bedroom. The owner was asked about this and was unable to say how this had occurred. The remains of a pink tablet was seen on the window sill of one persons room. The tablet could not be identified. Care Homes for Older People Page 14 of 41 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standard 12, Standard 13, Standard 14 Standard 15. Eating and delivery of food in the home has become chaotic and some individuals are not having their nutritional needs met as a result. Evidence: On both occasions the inspectors spoke with family members who said that they were happy with the staff at the care home and the care of their relatives. They were always made to feel welcome when they visited. Family members felt they were kept informed when their relative was unwell. There were no activities seen on the day of inspection despite having a person at the home who went in for day care. A care plan to address the nutritional needs of one of the individuals case tracked was in place but observation at lunchtime and teatime found that the care plan was not implemented. A family member was asked to verify the individuals eating habits that they had been asked to complete prior to coming to the home. They did this for the Care Homes for Older People Page 15 of 41 Evidence: inspector. The persons food was not presented attractively and was covered in gravy. The plan stated that the individual did not like gravy. The persons food was not attractively presented. They were observed to eat no lunch and only part of a sandwich at tea time. Staff appeared to lack direction about how to support a person to eat telling them not to leave the table until they had eaten something or the staff would get into trouble. The person became very distressed on hearing this and asked for somewhere quiet to go. At this point we intervened and asked the staff member to follow their request. A member of staff was heard by the inspector to say that she had to eat her lunch as the staff member stood over her. It was pointed out to this staff member that the individual may find them intimidating and that a better approach would be to sit with them and assist them. This person had eaten part of their pudding but was unable to finish it without support because it was served in a small metal bowl and they had a large metal spoon to eat with. This person was unable to manipulate this. Nothing was done to improve this situation for this person because when the inspectors returned this person along with another person was still seen to be struggling with their pudding. It was still being served in the same metal pudding bowl with the same large metal spoon. On day two of the inspection one person was left in charge of the dining room. Three people needed help and supervision with their meals they did not get this. Prescribed food supplements for these people were not offered either. A choice of two meals was available. A staff member had to be asked to change one of their gloves as they coughed into it whilst serving the roast potatoes and intended to carry on serving food. The glove was changed. This act demonstrates a poor level of awareness around the issues of food and hygiene. Staff members were called away from the dining room as three people waited for their lunch. A person with dementia was calling out in distress. One person in their bedroom became very angry and when they had to wait for their lunch. On both days of inspection the staff appeared to lack coordination when serving lunch and this had a negative impact on peoples enjoyment of their meals. For some people their nutritional needs were not being adequately met. There are currently insufficient numbers of staff on duty during meal times inexperienced staff members are left in charge of the serving of meals. Seven people needed direct support or encouragement to eat their meals to ensure they received adequate food and fluid. Three staff members are on duty over the lunch time period. However the previous rota for December 2008 used by the home showed that one person leaves at 1 pm and the next person on shift comes on at 2 pm when lunch is over. Care Homes for Older People Page 16 of 41 Care Homes for Older People Page 17 of 41 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standard 16 and Standard 18 Links with external agencies are weak with little evidence of the service being open or proactive in the areas of protection. Evidence: Visitors and staff who spoke with the inspectors felt that they would be listened to if they had a concern or needed to make a complaint. Staff who spoke with the inspector spoke about how a person living at the home had had their movements restricted at the time they had not been aware that this would be classed as abuse . Staff said they were told that the family had agreed to this. There was no risk assessments in the care records to explain how this decision had been reached. The individual had dementia and the staff thought that it was acceptable to prevent them from wandering around the home in this way. In accident records individuals had fallen out of bed and were advised to use the buzzer despite them having severe dementia. Another person had a cut ear the action plan put into place was to make sure that they were close to the wall when they went to bed and to observe them closely. With one person on night duty this would not have been possible to do. The same person was reported to have fallen over, banged their Care Homes for Older People Page 18 of 41 Evidence: head and had a lump on their head but was reported to be alright. The risk was identified as the bump on the head. There was no indication of a follow up by the persons doctor for this head injury. Staff giving medication have been found to be in need of further training in medications. Individuals have been seen to not be eating, have lost weight and it has been left unmonitored. Staff have been found to be in need of further training in issues such as moving and handling, pressure area care, food hygiene, recording and monitoring of care given. In this way individuals can no longer be said to be fully protected by the staff at the care home. Care Homes for Older People Page 19 of 41 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standard 19, Standard 20, Standard 22, Standard 24, Standard 25, Standard 26 The home is not always kept clean or well maintained. Evidence: Areas of the home needed cleaning. The inspector was told by an agency care not to sit on one of the chairs in the top lounge as it was not clean. Someone had been incontinent while sitting on it and because it was an electric recliner the staff were unsure as to how it should be cleaned. The majority of peoples bedrooms were inspected. Radiators in rooms were unprotected and very hot. This has the potential to cause burns to the skin if accidentally in close contact with them. Radiators in communal areas also posed the same risk. Some of the furniture in peoples bedrooms needed repairing or replacing. There was only evidence of one lockable storage facility in one persons room yet there are people living there who are responsible for keeping their own money safe but without the correct facilities it is impossible to do so. Windows in and around the home were in need of repair and fasteners needed repairing also. One room window could not be fastened as it was broken. This is a potential risk to the safety of any one living or working at the home. There was no evidence of window restrictors on the windows. The external kitchen door and some of the downstairs toilet areas are difficult to close and open. Paper towels and soap was Care Homes for Older People Page 20 of 41 Evidence: seen in communal areas but in some places bins were either absent or not suitable. Disposable gloves were seen although only the small sizes was seen however a staff member said that other sizes were also available if you asked for them. One member of staff was asked about infection control. They said that they had completed training in this area. There was no documentary evidenced to support this. The inspector had witnessed poor practice in this area. External doors within the home did not have alarms on them. This is a home for people with dementia and if they were to leave the building it would be some time before the staff would be made aware of them being missing. The front door posed a potential fire risk as it was locked with a bolt and key and was difficult to open. An immediate requirement was left for this to be resolved and an inspection by the fire officer. On 07/01/09 the fire officer visited and left information for the owner to action. The consultant management team have already started to work with the owners to resolve these issues. There are four steps on one of the corridors in the home a stairlift is fitted by the steps. The stairlift is not used by staff routinely although it does work albeit slowly. Some people cannot use the steps or the stairlift due to their physical disabilities. Access to certain parts of the home such as the dining room is difficult to get to. Staff were reported to have been taking people outside the building to over come this problem. This was not acceptable and the consultant management team stopped this practice. Two wheelchairs seen in peoples rooms were not clean and one did not have foot plates on it. An Occupational Therapist assessment is needed for a bedroom where by the bed-cradle is being used to assist the person to get up. Areas of the home are quite dark this has the potential of contributing to falls. Improvements to this aspect of the home would be beneficial to everyone living and working at the home. Care Homes for Older People Page 21 of 41 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standard 27, Standard 28, Standard 29 and Standard 30 Staffing levels do not appear to be able to meet the needs of individuals living at the home. This has an impact on the care given. Evidence: Information obtained during the inspection visits indicates that the owners recruitment practices does not ensure that people living at the home are safeguarded. Eleven staff records were inspected. The owner said that they were complete staff records. Five staff records had completed Criminal Records Bureau checks before they started work in the home. There was no evidence to say that they had had a Protection Of Vulnerable Adults first check, made before they started working the home. Training records indicated that the majority of staff had received basic training such as first aid and food safety one person had received dementia care training. One staff member said that they had to look after the home when more senior staff went on training and had not had training beyond basic training themselves. Three people had an National Vocational Qualification level 2 in care. There was no safeguarding training since 2005 for any staff. Two staff records had supervision but regular supervisions were not apparent from the records. Staff being observed and corrected in practice was not evident. Care Homes for Older People Page 22 of 41 Evidence: Domestic staff was seen assisting at meal time. Domestic staff was enrolled to do an NVQ in care and as part of their learning was to do at least one care shift. However one of the domestic staff was only eighteen doing care shifts at the time and was unsupervised when she worked alone on nights. Care staff undertake domestic duties during the days and also at night. This has the potential of compromising care required by individuals. This time should be spent providing care, recording and updating care plans. Care Homes for Older People Page 23 of 41 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standard 31, Standard 33, Standard 35 and Standard 38 Health and safety concerns, lack of resources and poor management mean that individuals living at the home are not adequately protected or safe within the home. Evidence: Staff in the home lack clear direction as to how to meet the needs of individuals. On both days the inspector observed staff serving meals to individuals at the home. Meal times lacked coordination and more one to one assistance was needed for a large number of people at the home. Evidence from previous outcome groups indicates that insufficient attention has been paid to staff recruitment and training. Staff supervisions were not always completed and staff were not observed in practice to ensure that they had good competency skills such as moving and handling or assistance of an individual during meal times. The Care Homes for Older People Page 24 of 41 Evidence: Registered Manager tended her registration to the responsible individual (owners) on 7th January 2009. The ongoing management arrangements for the home were unclear until a strategy meeting that took place on 8th January 2009 when the owners re engaged the consultancy management team to take over the running of the home. Improvements in health and safety practices are required within the home. All radiators need to be assessed and those that are found to be excessively hot requires action to ensure that they do not present a risk of burning. Finance for a few individuals was checked. There was no evidence of a reimbursement of individual monies stolen earlier in the year. (The money was mainly used for payments to the hairdresser or chiropodist.) The owners now take greater responsibility for money that they keep on behalf of individuals. However, for individuals who keep their own money few of the rooms have adequate security for this to be safe at this moment in time. Care Homes for Older People Page 25 of 41 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action 1 1 4 (1) (c) The Statement of Purpose 31/10/2008 and Service User Guide must be reviewed to contain the information that an individual coming into the home should have. 2 26 13 (4) (a) (c) Facilities for the washing and 31/10/2008 drying of hands should be provided. Bins that can avoid being opened by hand should be considered to avoid the risk of cross infection from disease and contamination. 19 A review of all staff records 31/10/2008 must be done to ensure that they comply with the Care Standards Act 2000. Good recruitment practices must be followed at all times as this could potentially put the people living at the home at risk from people who do not meet the Criminal Records Bureau (CRB) checks. 3 29 Care Homes for Older People Page 26 of 41 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 22 13 The registered person shall 08/01/2009 ensure that (4)(c) all unnecessary risks to health or safety of service users are identified and so far as possible eliminated. Call systems with an accessible alarm facility must be provided in every room be in good working order and placed where individuals can reach them. 2 22 13 The registered person shall 08/01/2009 ensure that (4)(c) all unnecessary risks to health or safety of service users are identified and so far as possible eliminated. Individual needs must be assessed for access to all parts of the home where steps or chairlifts have been provided. 3 24 23 (4) The registered person shall after consultation with the fire authority provide adequate means of escape. Access and Exit door should be easy to open in the event of a fire. The front door bolt and locks need to comply with this. 08/01/2009 4 25 13 The registered person shall ensure that c) all unnecessary risks to the health and safety of service users are indentified and so 08/01/2009 Care Homes for Older People Page 27 of 41 far as possible eliminated. An assessment for radiators within the home have still not been done and it is essential for the safety of all individuals living at the home. Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 14 The registered person shall 08/02/2009 not provide accommodation to a service user at the care home unless, so far as it shall have been practicable to do so - a) needs of the service user have been assessed by a suitably qualified or suitably trained person d) the registered person has confirmed in writing to the service user that having regard to the assessment the care home is suitable for the purpose of meeting the service user ss needs in respect of his health and welfare. Information about the home must be readily available and up to date so that individuals can make an informed decision about where to live. 2 3 14 The registered person shall not provide accommodation to a service user at the care 08/02/2009 Care Homes for Older People Page 28 of 41 home unless, so far as it shall have been practicable to do so - a) needs of the service user have been assessed by a suitably qualified or suitably trained person d) the registered person has confirmed in writing to the service user that having regard to the assessment the care home is suitable for the purpose of meeting the service user ss needs in respect of his health and welfare. A full assessment of any individuals needs must be done so that staff will know what their needs are and be able to check whether they have the skills to meet those needs and decide if further information is required. 3 4 14 The registered person shall 08/02/2009 not provide accomodation to a service user at the care home unless, so far as it shall have been practicable to do so - a) needs of the service user have been assessed by a suitably qualified or suitably trained person d) the registered person has confirmed in writing to the service user that having regard to the assessment the care home is suitable for the purpose of meeting the service userss needs in respect of his health and welfare. Care Homes for Older People Page 29 of 41 The registered person must be able to demonstrate the homes capacity to meet the assessed needs (including specialist needs) of the individulas admitted to the home. 4 7 15 Unless it is impractical to 08/02/2009 carry out such consultation, the registered person shall after consultation with the service user, or a representative of his, prepare a written plan the service users plan as to how the service users needs in respect of his health and welfare are to be met. All care plans must be regularly updated and reviewed to ensure that they reflect the changing needs of the people living in the home and to ensure there is consistency of care. 5 7 15 Unless it is impractical to 08/02/2009 carry out such consultation, the registered person shall after consultation with the service user, or a representative of his, prepare a written plan the service users plan as to how the service users needs in respect of his health and welfare are to be met. Staff need guidance as to how they should carry out effective care that will meet Care Homes for Older People Page 30 of 41 the needs of the individuals who they provide care for. 6 8 13 (5) The registered person shall make suitable arrangements to provide a safe system for moving and handling service users This will avoid unnecessary discomfort or injuries to individuals. 7 8 13 The registered person shall make arrangements for service users (1) (b) to receive where necessary, treatment, advice and other services from any health care professional. The registered person shall ensure that (4)(c) unnecessary risk to the health and safety of service users are identified and so far as possible eliminated. A clear policy must be put in place stating the response staff must take with regards to accidents and in particular head injuries. This is to ensure that individuals will receive adequate medical attention. 8 8 13 The registered person shall ensure that (4)(c) unnecessary risk to the health and safety of service users are identified and so far as possible eliminated. All individuals identified as being at risk must then have 08/02/2009 08/02/2009 08/02/2009 Care Homes for Older People Page 31 of 41 a careplan in place to say how this risk is being managed. In this way individuals with pressure areas will receive appropriate support. 9 8 13 The registered person shall ensure that (4)(c) unnecessary risk to the health and safety of service users are identified and so far as possible eliminated. A pressure area assessment must be completed for all people living in the home. This is to ensure that preventative measures can be put in place. 10 8 12 The registered person shall ensure that the care home in conducted so as to promote and make proper provision for the health and welfare of service users. A care plan must be put in place for all individuals living at the home identified as needing help to maintain good nutrition. The care plan must outline how their nutritional needs and weight loss is to be managed and the exact support that care staff must give to do this. 11 9 13 (2)The registered person 08/02/2009 shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the home, 08/02/2009 08/02/2009 Care Homes for Older People Page 32 of 41 Only staff deemed to be competent should be given the responsibilty to administer medications. This is to ensure that medication is administered safely. 12 10 13 The registered person shall 08/02/2009 make suitable arrangements to ensure that the care home is conducted (a) in a manner which respects the privacy and dignity of service users. All individuals living at the home are entitled to be treated with respect. Staff must be able to demonstrate this in all interactions with each individual. 13 10 13 (6) The registered person shall make arrangements, by training staff or other measures to prevent service users being harmed or suffering or being placed at risk of harm or abuse. Care practices have identified that staff are unsure as to what they need to do and how abuse can take place intentionally and un-intentionally. In this way all individuals will be protected from abuse. 14 12 16 (2) The registered person shall having regard to the size of the care home and number and needs of the service users n) consult service users 08/02/2009 08/02/2009 Care Homes for Older People Page 33 of 41 about the programme of activities arranged by or on behalf of the care home,, and provide facilties for recreation including, having regards to the needs of services, activities in relation to recreation, fitness and training. Activities must be provided to improve the daily experiences of the individuals living at the home. Individuals with dementia need to be provided with activities appropriate to their condition. 15 14 16 Subject to regulation 4 (3) the registered person shall provide facilities and services to service users in accordance with the statement required by regulation (4) (l) (b) in respect of the care home. Individuals must be allowed to exert their choices even if it will take more time than anticipated. 16 15 16 (l) to provide in adequate quantities, suitable, wholesome and nutritious food which is varied and properly prepared and available at such time as may reasonably be required by service users. Food should be served in a way that makes it attractive 08/02/2009 08/02/2009 Care Homes for Older People Page 34 of 41 to the people living in the home. This includes ensuring that they have a choice about what to eat and where to eat it. 17 18 13 On any occasion on which a service user is subject to physical restraint, the registered person shall record the circumstances, including the nature of the restraint. The registered person must seek the advice of health care professionals when they are unsure about how to manage a situation as they could be placing individuals in their care at risk. 18 19 13 All areas of the home must be maintained and kept in a good state of repair. This is to ensure that individuals live in a safe and well maintained environment. 19 20 13 The registered person shall ensure that (4)(c) all unnecessary risks to health or safety of service users are identified and so far as possible eliminated. Lighting in communal areas are domestic in character, they must be sufficiently bright and positioned to facilitate reading and other activities. This will avoid 08/02/2009 08/02/2009 08/02/2009 Care Homes for Older People Page 35 of 41 unnecessary injuries such as falls. 20 22 13 The registered person shall ensure that (4)(c) all unnecessary risks to health or safety of service users are identified and so far as possible eliminated. Adaptations such as the steps or bed cradle as examples have been assessed for safety and the appropriate advice has been obtained. 21 24 13 The Registered person shall ensure that (4)(c) all unnecessary risks to health or safety of service users are identified and so far as possible eliminated. Lockable storage facilities must be provided for valuables and is provided with a key which he or she can keep unless the reason for not doing so is explained in the care plan. 22 26 13 The Registered person shall ensure that (4)(c) all unnecessary risks to health or safety of service users are identified and so far as possible eliminated. All areas of the home must be kept clean and free of offensive odours. THis is to ensure that people live in a clean and safe environment. 23 26 13 The Registered person shall ensure that (4)(c) all 08/02/2009 08/02/2009 08/02/2009 08/02/2009 Care Homes for Older People Page 36 of 41 unnecessary risks to health or safety of service users are identified and so far as possible eliminated. All areas of the home must be maintained and kept in a good state of repair. This is to ensure that people live in a safe and well maintained environment. 24 27 18 The registered person shall, 08/02/2009 having regard to the size of the care home, the statement of purpose and the number and needs of service users (a) ensure that at all times suitably qauified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. This is to ensure that there are sufficient staff on duty at all times. 25 28 18 The registered person shall, 08/02/2009 having regard to the size of the care home, the statement of purpose and the number and needs of service users (a) ensure that at all times suitabley qauified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. A minimum ratio of 50 Care Homes for Older People Page 37 of 41 trained members of care staff (NVQ level 2 or equivalent must be achieved and maintained. In this way individuals living at the home will be in safe hands. 26 29 19 The registered person shall 08/02/2009 not employ a person to work at the care home unless a) the perosn is fit to work at the care home; (b) subject to paragraph (6), he has obtained in respect of that perosn the informatin and documents specified in (i) paragraphs 1 to 7 of Schedule 2 (c) he is satisfied on reasonable ground as to the authernticity of the references referred to in paragraph 5 of schedule 2 in respect of that person. The registered person must not employ anyone unless they have first obtained two written references for that person. This is to ensure that only suitable people work in the care home and individuals are not placed at risk. 27 29 19 The registered person shall 08/02/2009 not employ a person to work at the care home unless a) the perosn is fit to work at the care home; (b) subject to paragraph (6), he has obtained in respect of that perosn the informatin and documents specified in (i) paragraphs 1 to 7 of Schedule 2 (c) he is satisfied Care Homes for Older People Page 38 of 41 on reasonable ground as to the authernticity of the references referred to in paragraph 5 of schedule 2 in respect of that person. Enhanced Criminal Record Bureau checks must be obtained first in respect of that person and checked against the vulnerable adults register. This is to ensure that only suitable people work in the care home and individuals are not put at risk. 28 30 18 The registered person shall, 08/02/2009 having regard to the size of the care home, the statement of purpose and the number and needs of service users (a) ensure that at all times suitabley qauified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. As this is a home with dementia people living in it all staff must receive training in this area of care. 29 37 37 The registered person shall 08/02/2009 give notice to the Commission without delay of the occurence of any notification of any death, illness and other events. Any event that adversely affects the well being of or Care Homes for Older People Page 39 of 41 safety of any individual must be reported per Care Standards Act 2000. 30 38 13 The registered person shall ensure that (4)(c) all unnecessary risks to health or safety of service users are identified and so far as possible eliminated. External doors on the ground floor of the home should be appropriately alarmed. In this way staff will be made aware when vulnerable adults leave the building. 31 38 13 The registered person shall ensure that (4)(c) all unnecessary risks to health or safety of service users are identified and so far as possible eliminated. All areas of the home that should not be accessible to individuals living at the home should be kept secure. 08/02/2009 08/02/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 15 Consideration should be given to the cutlery and crockery used by individuals so that it does not restrict indviduals from being able to feed themselves. Care Homes for Older People Page 40 of 41 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 41 of 41 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!