Inspection on 16/01/07 for The Ridings

This inspection was carried out on 16th 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 Ridings 08/10/09

The Ridings 06/11/08

The Ridings 20/11/07

The Ridings 29/05/07

The Ridings 30/08/06

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

CARE HOMES FOR OLDER PEOPLE The Ridings Farnborough Road Castle Vale Birmingham B35 7JG Lead Inspector Sean Devine Unannounced Inspection 16th January 2007 09:30 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 Ridings DS0000067308.V326276.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 Ridings DS0000067308.V326276.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Ridings Address Farnborough Road Castle Vale Birmingham B35 7JG 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) 0121 748 8770 0121 747 0163 Dukeries Healthcare Pauline Starrs Care Home 82 Category(ies) of Dementia (20), Dementia - over 65 years of age registration, with number (62) of places The Ridings DS0000067308.V326276.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home can accommodate up to 82 people in total within the following categories: A maximum of 20 people under the age of 65 years of age can be accommodated to include 11 people also receiving nursing care. In addition 5 of the 20 beds can be used for either care (maximum 25 care only) or care with nursing (maximum 16 nursing care). A maximum number of 62 people can be accommodated over the age of 65 years for reasons of dementia to include 34 persons also receiving nursing care. In addition 5 of the 62 beds can be used for either care (maximum of 23 care only) or care with nursing (maximum 39 nursing care) One named resident over the age of 65 years can be accommodated on the nursing unit for people under the age of 65. 30th August 2006 2. Date of last inspection Brief Description of the Service: The Ridings is a large care home in Castle Vale that has been built by the Dukeries organisation It is registered to provide a service for upto 31 younger adults with a dementia of whom 11 can receive nursing care and upto 51 older adults with a dementia of whom 34 can receive nursing care. The residents’ rooms all have en-suite facilities and are spread across six independent units, at the time of writing the report the home had 67 residents and all of the six units were open. All units have their own dining room and lounge areas. Each independent unit has a fully adapted bathroom and a shower room to meet a wide range of movement and mobility needs; nine toilets some being spacious for use by wheelchair users are available across the home close by residents’ rooms. All areas of the home including the first and second floors are accessible by a large passenger lift. The service plans to provide a specialist service for residents who are of working age and have a dementia with a focus upon assessment, rehabilitation and where needed longer term care and support. There are enclosed gardens for residents on all units to experience, however at present much of the plant life needs to mature. There is a large car park at the front of the building. The home is close by many bus and rail routes in and out of the city. The Ridings DS0000067308.V326276.R01.S.doc Version 5.2 Page 5 The pre inspection questionnaire completed by the manager of the home indicated the current scale of charges for this service ranges from £548.00 to £1034.00 each week. The Ridings DS0000067308.V326276.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection was conducted unannounced over two full days, day one, the 16th January 2007 by three Regulation Inspectors, one Regulation Manager and a Pharmacy Inspector and day two, the 19th January 2007 by two Regulation Inspectors. Five residents were case tracked one resident on Ascot Unit and four residents on Aintree unit, this also included checking care records, meeting them and viewing their accommodation. One resident had since left the home and a relative had made a complaint that was investigated by the Commission at this key inspection. Complaints records indicate that the home has received twelve complaints since August 2006. Three of which were received at the Commission and the home were asked to investigate and respond. Some residents were able to indicate whether they were happy or not through their body language and verbal tone; some residents in the inspectors’ opinion were in a state of ill being, most residents due to their type of dementia were unable to share their views and opinions about the services they receive. Three relatives / visitors shared their comprehensive views and opinions about the home. The pharmacist inspector visited the home and undertook audits for randomly selected residents medication for all six units, interviewed relatives and staff and observed practice of administration by staff. Feedback was given at the end of the pharmacist inspection to the registered person and the acting manager. The registered person and the acting manager were both advised that there were some very serious poor practice issues on Aintree unit that put the health and welfare of residents at high risk, this has resulted in the issue of a Statutory Requirement Notice. If significant improvement is not made within the timescales set the home may be liable for prosecution. On day one of the inspection the home was issued an immediate requirement to make safe an exposed electrical light fitting in the bathroom on Aintree residential unit. There were also several discussions between the inspectors, staff, management and visitors about the excessive heat in some parts of the building, which was uncomfortable, hot and clearly would have an impact on the health of residents. On day two the repair to the light fitting had been completed and the building in many areas was cooler. Both inspectors gave feedback to the acting manager and the registered person, advising of many areas that require The Ridings DS0000067308.V326276.R01.S.doc Version 5.2 Page 7 improvement. There was some acknowledgement of progress against some of the requirements issued at the last inspection. What the service does well: What has improved since the last inspection? What they could do better: The home has been issued forty five (45) requirements where there have been breaches of the Care Home Regulations 2001 and four (4) recommendations The Ridings DS0000067308.V326276.R01.S.doc Version 5.2 Page 8 where there are suggestions to improve their practices. A summary of the requirements is as follows; Choice of Home All residents or where needed their representative must be provided with a copy of the service users guide. Pre admission assessments need to include more information about the strengths and needs of each prospective resident. Health and Personal Care Care plans must be inclusive and wherever possible involve the resident or their representative, they must be written in a clear and concise way. All staff must follow these care plans and ensure that all residents are treated with respect and dignity. Staff must ensure they do not put residents at risk by for example, forgetting pressure relieving cushions or not fitting hearing aids. The management and administration of the residents’ medicines must be improved without delay to ensure all medicines are safely stored, administered and disposed of and that poor practices and errors are eradicated, if this does not happen it may well have very serious consequences for some residents. Daily Life and Social Activity There continues to be a general lack of opportunity for residents, there are some reasons why; including lack of staff for activities, poor staff attitudes towards care, a lack of staff training with emphasis on engaging / communicating with people with a dementia and a lack of good assessments and care plans (activity programmes) to help guide staff. Complaints and Protection All complaints need to receive a timely response as indicated in the homes policy. The management team must ensure that relevant agencies are always informed without delay about possible concerns that may be abusive in nature. Environment The main concern continues to be that the building is not decorated in such a way that will help people with a dementia. The walls and doors are similar in colour and there are areas with no signs, both do not help residents recognise where they are or want to be. There are long corridors without any areas to interest residents or to help staff communicate with residents. The Ridings DS0000067308.V326276.R01.S.doc Version 5.2 Page 9 Infection control practices need to be improved, including ensuring there is adequate arrangements for cleaning at all times of the day and night, and residents’ clean clothing and towels are always safely stored. Staffing The management team must ensure that at all times there are adequate numbers of skilled, competent and experienced staff are on duty to meet the needs of residents. Staff training has to be improved including dementia awareness, nationally accredited awards and areas of safe working practice training. There should also be consideration to training more staff about the specific needs of residents. Management and Administration The acting home manager should have some additional support to manage such a large home, possibly a deputy manager who has experience and knowledge of caring for adults with dementia in both residential and nursing establishments. It is a concern that residents’ belongings go missing, these are at times valuables such as watches and broaches or aids such as dentures or hearing aids. Systems to protect residents’ belongings must be improved and where required the items need to be replaced. Care staff must receive closer and more regular supervision. Residents’ records must be safely and securely maintained, missing documents must be found; the Commission must be informed of all incidents that have an effect on the well being of residents. The home must ensure that when the call bell is activated that staff respond quickly and that a master key is available on all units to allow staff access to all rooms in an emergency. The staff must ensure that all fire doors are maintained so that they will close if the fire system is activated and that they are not wedged open. The home must ensure that all COSHH products are securely stored and that the bolts are removed from the outside of the quiet room door on Aintree unit The Ridings DS0000067308.V326276.R01.S.doc Version 5.2 Page 10 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 Ridings DS0000067308.V326276.R01.S.doc Version 5.2 Page 11 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 Ridings DS0000067308.V326276.R01.S.doc Version 5.2 Page 12 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): Standards 1, 3 and 6. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has not fully demonstrated that it has an effective process to enable prospective residents to choose a home that will meet their needs and expectations. This may lead to the residents being admitted to the service that may not be suitable for them. EVIDENCE: The pre admission assessments for two of the five residents were seen. The assessments for one resident were completed by the home prior to admission, on admission and following admission. Many of the activities of daily living (ADL’s) had been considered, however records were rather brief, there was also a report from the hospital where the resident had been admitted from. The Ridings DS0000067308.V326276.R01.S.doc Version 5.2 Page 13 For another resident the pre admission assessments were also available, again completed by the home at the hospital where the resident was a patient, there was not a lot of information recorded and it referred to all the residents ADL’s. The resident also had an old care plan written by her social worker following an assessment for home care. Two relatives confirmed that they were able to come and see the home before making a decision on whether it would be the right place. One relative said it was the nicest place he had ever seen. Both relatives explained that they were not provided with a service users guide prior to the admission of the residents. The care home does not provide an intermediate care service. The Ridings DS0000067308.V326276.R01.S.doc Version 5.2 Page 14 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): Standards 7, 8, 9 and 10. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home has not demonstrated it has the ability to meet the health and personal care needs of residents. Healthcare and support afforded to residents is not administered safely including poor medication and tissue viability, which is detrimental to their health and there is evidence that staff in the home treat residents in a way, which does not respect their privacy and dignity. EVIDENCE: The personal care and health for the five residents was case tracked. All residents did have some written care plans available for the needs identified in the activities of daily living assessments. However some of the assessments such as for hobbies and interests were incomplete and the description of behaviours displayed such as “has flirty periods” is a concern. Some care plans were well written providing clear and concise information for staff about how they support residents. However some care plans were poor, for example a personal care, care plan advised staff to assist with no The Ridings DS0000067308.V326276.R01.S.doc Version 5.2 Page 15 information of what the resident can do for herself and in which areas staff need to provide assistance. A care plan was available for a resident about nutrition, it implied that a dietician should be contacted yet there was no evidence this had been done. Another care plan describes that a residents’ mobility is failing and that support from staff is required, it does not describe what support. There are also care plans about promoting choice, this is positive yet they were very brief and mainly included choice of food, when residents are able to make many more choices about their lives. For one resident twenty-three care plans had been written, where one or two had been duplicated and where it was not clear about the residents’ level of mobility. Another resident had a care plan about communication, including the importance of wearing a hearing aid, when the inspector met with the resident no hearing aid was being worn by the resident. For this resident a care plan about nutrition was available and there was evidence that the dieticians’ advice had been included within the plan. There was a care plan for one resident who requires support to relieve the pressure on certain bodily parts, the care plan was brief but did include providing pressure relieving cushions, one inspector observed the resident sitting in an armchair for in excess of two hours without the cushion. One care plan for the mental health needs of a resident stated unaware of mental state, this was clearly an assumption and it was evident on meeting the resident that she was aware when she was happy but was not able to talk about herself due to her dementia illness; the care plan also included not telling the truth to the resident about why she was living in the home. The sampled care files included current risk assessments; these were available for skin integrity (waterlow assessment), nutritional risk assessments, falls risk assessments and moving and handling risk assessments. The risk assessments were found to have management plans, however they do need to be improved for example the moving and handling risk assessment must contain information about equipment used such as type of hoist and size of sling; there were also more personal risk assessments available where needed such as for health conditions, however for one resident a challenging behaviour risk assessment had a management plan that was poor, including describing changing mobility needs that were not pertinent to any behaviour. Records of when residents have appointments with community healthcare services were available including, their GP, dentist and other primary care services such as district nurses on the residential unit, chiropody, opticians and dieticians. There were also records of when residents needed to go into hospital. A complainant had raised concerns that an accident to her mother had been poorly managed by the home, that records were poor and it appeared that her mother had an accident and attended hospital some three hours after the accident and records do indicate this. There were also concerns raised by a complainant that in her opinion the home would not accept that the resident had a fracture following this accident, and that after The Ridings DS0000067308.V326276.R01.S.doc Version 5.2 Page 16 being informed by the complainant that her mother did have a fracture they did not respond quickly, according to records the GP confirmed no fracture, hospital staff some one week later confirmed to staff at the home there had been a fracture. However the complainant informed the home that her mother had a fracture some one week earlier and this is recorded in daily reports. Report by D Railton. The pharmacist inspector visited the home and undertook audits for randomly selected residents’ medication for all six units, interviewed relatives and staff and observed practice of administration by staff. Feedback was given at the end of the pharmacist inspection to the registered person and the acting manager. The home has five medication rooms, and a medication trolley secured to the wall in the residential unit’s dining room. Two of the medication rooms were too hot to safely store medication within, as was the dining room on the residential unit (Aintree). All medicines must be stored below 25°C in line with their product licences to maintain their stability. The residential unit Serious concern was raised regarding the medicine management on Aintree residential unit, resulting in the issue of a Statutory Requirement Notice, which was later rescinded due to a processing error. If significant improvement is not made within the timescales set the home may be liable for prosecution. Hand written medicine charts were poor. They did not always record the start date of the chart, strength of the tablets, and dose regime as stated on the label or the quantity of medication received into the home. A copy of the prescription was not readily available for staff to check the entries on the chart for accuracy throughout the cycle. Inadequate checks were made for medicines bought into the home for new residents who come to live in the unit. One label had the incorrect name of the resident printed. This was crossed out and changed to another resident. It could not be demonstrated that these actually belonged to the resident as renamed by the staff hand written on the medicine chart. Any dispensing errors or discrepancies should be checked and addressed by the pharmacist. This highlights also that systems to check medication into the home are poor. Staff should be able to confirm exactly what the doctor prescribed easily and be able to check for potential dispensing errors. One additional medicine was handwritten on the medicine chart and recorded a different strength of medication to that available in the medicine trolley. It could not be demonstrated exactly which strength of medicine the resident should have had. A balance of three capsules were recorded as carried over from the previous medicine chart but staff had signed they had administered 14 capsules from that date. There were 16 capsules from 28 dispensed of the different strength remaining in the trolley. Two gaps were also seen and it could not be demonstrated exactly what had occurred on these The Ridings DS0000067308.V326276.R01.S.doc Version 5.2 Page 17 two dates, whether medication had been administered and not recorded or not administered and the reasons for non-administration not recorded. The same resident did not have adequate pain relieving tablets available for one day as they were recorded as out of stock. Staff had not ordered a new supply in sufficient time to ensure that she did not run out of medication. A similar occurrence was seen for another medicine for her when a medicine was not administered as out of stock. This is unacceptable as staff should make sure there are enough medicines to administer to the residents as the doctor prescribed. The medication was scattered throughout the trolley, making it difficult to find the correct medicine easily for each resident. This may lead to staff not administering the medication, as they cannot find it. Unlabelled medication was found in the trolley. One bottle of eye drops was found with no label and no date of opening. These must be discarded after 28 days otherwise the risk of microbial contamination may occur. All medicines must be administered from a pharmacist labelled container at all times to ensure they are administered to the right service user, at the right dose and have recently been prescribed. The home used a Monitored Dosage System (MDS) where the pharmacist puts each daily dose in a blister pack to make it easier for staff to administer medicines. These blister packs did not start the same time as the medicine chart. Usually they start at the same time each 28-day cycle. This makes it easier to audit exactly what has occurred, for the care assistants to select the correct medicine and also to quickly check that the dose has been administered that day. This could not occur. A divider on the rack separated each resident’s blisters. However some resident’s medicines were found with other resident’s blisters, which may result in the incorrect medication being administered to the wrong resident. Medicines that cannot be dispensed into MDS are dispensed in traditional boxes and bottles. Up to four boxes were in use at the same time for one resident. As one capsule was missing at the time of the inspection the possibility of this particular medicine being administered twice could not be discounted. Only one box of medicine should be used at once and any surplus stored separately to reduce the risk of them being administered more than once. Gaps were seen on the medicine chart. It could not be demonstrated exactly what had happened for some medication. Medicines may have been administered but not recorded as such or not administered and the reasons for non –administration not recorded. Some reasons for non-administration were The Ridings DS0000067308.V326276.R01.S.doc Version 5.2 Page 18 regularly recorded as O (other) with no explanation as to why the medicines were not administered. Conversely some medicines had been recorded as administered when they had not been. One care assistant was seen by the inspector administering a medicine to a resident. The care assistant pushed the tablet into her mouth using her finger. She subsequently fell asleep and the tablet was seen to sit on the lips. She had not swallowed it. The care assistant had handled the medication without using gloves, pushed the tablet into her mouth with her finger and left her to swallow it without helping her to wash it down with a drink. This practice is unacceptable. It may increase risk of choking. The care assistant signed the medicine chart that she had administered the medicine even though the resident had not swallowed it. One relative spoken with during the inspection expressed concern regarding the care his mother received. “My mother is always dehydrated. She was never constipated until she came to live in this home. She has lost weight and they have lost her false teeth and glasses … and her clothes and slippers….. The other day they gave her someone else’s liquidised food which had been prepared for another resident” The temperature in the dining room at the time of the inspection was 27°C with the windows open. This would compound her dehydration. It was also noted that the home was out of stock for one medicine prescribed to relieve her constipation for the third consecutive day. The relative queried a dose regime. The dose was one tablet twice a day. This was recorded as administered at 9am and 1pm. The medication round is sometimes not completed until 10:30am. This leaves inadequate time between the next drugs round. At least four hours should be left between doses to allow sufficient time for the medicine to be absorbed and metabolised in the body. This may increase the incident of any adverse effects experienced by the resident and possible overdose for some medication. During feedback this was raised and the acting manager said she had contacted the doctor about this. However the dose regime was clear as it was prescribed twice a day, which usually means twelve hours apart unless the doctor specifically directs otherwise. This dose regime was confirmed by the drug company that manufactures the medication who confirmed that this particular medicine was to be administered twice a day as near to twelve hours apart and taken with meals usually with breakfast and the evening meal to aid absorption. Staff are failing to interpret the directions by the doctor correctly which may lead to an increase in adverse effects experienced by the residents. The Ridings DS0000067308.V326276.R01.S.doc Version 5.2 Page 19 Some medicines were prescribed on a “when required” (or prn) basis. None had a supporting “prn” protocol detailing their exact use so they are administered only as the doctor intended. Controlled Drugs were stored in the trolley and not in a Controlled Drugs cabinet as stated in the National Minimum Standards. The home recorded all CD administrations in a CD register. A second member of staff had not witnessed some transactions. The medicine charts were left on top of the trolley. Any visitor, staff or service user had access to these confidential records. These should be stored in a secure place to ensure that confidential information is not readily accessible to people who are not at liberty to read it. The home operates a homely remedy policy where staff can administer medicines for minor ailments without referring the resident to the doctor. No homely remedies were found for this unit and the policy contained many medicines that were inappropriate for care assistants to administer. The nursing unit. Two of the five medication rooms on the nursing units were too hot to safely stored medication. One refrigerator was used to store medication did not store them in compliance with their product licences. Temperatures recorded indicated that at some point the refrigerator was too hot or too cold. All medicines requiring refrigeration must be held between 2°C and 8°C at all times. This did not appear to happen. Nursing staff had failed to act when the temperatures fell outside these limits. One medicine was stored in the trolley and not the refrigerator. It could not be guaranteed that this would still work, as it had been stored at too high a temperature. Whilst some quantities of medicines received were recorded not all carry over balances from previous cycles were. This resulted in the inspector being unable to verify exactly what had been administered in all instances. Audits indicated that some medicines were unaccounted for. Conversely medication had been recorded as administered when they had not been. Medicines had run out and a new supply had not been sought resulting in some residents not having medication for pain relief available. Again problems were seen with the dividers placed on the MDS rack separating resident’s medication. Some blister packs were found with other resident’s blisters next to the wrong divider. This again could result in the wrong resident being administered another residents medication. One inhaler was prescribed to be used when required but this was administered routinely at the same time each day. Another had been prescribed to be used twice a day but nurses routinely administered this each morning only. The Ridings DS0000067308.V326276.R01.S.doc Version 5.2 Page 20 One medicine had been recorded at a dose of 2.5mg. A 3mg tablet was recorded as administered for this dosage regime and nurses had recorded they had administered 2.5mg from this. Nursing staff would have been unable to do this. The home did have a supply of 5mg but they did not administer the 2.5mg dose using half a 5mg tablet. The home did not have a supply of 1mg tablets so 2.5mg (two and a half tablets) could not have been administered from these, even though at some point these had been prescribed. This indicates that nurses are not administering all medication exactly as the doctor prescribed and do not think about the best way to actually administer some dose regimes. In addition the actual dose of the medication the resident was supposed to be administered could not be verified. Medicines prescribed to be administered on a “when required” basis did not have any supporting protocols detailing their use. The Controlled Drug register did not reflect the administration of some CD as recorded on the medicine chart. These should match as nurses should record their administration on the medicine chart and in the CD register and a second nurse should record they have witnessed the transaction. Not all transactions were witnessed by a second nurse. One medication trolley could not be locked. This is of serious concern, as the medicines could not be locked away in the event of an emergency increasing the risk to the residents who live in the home. One nurse said that if an emergency occurred a care assistant would stand by the medicine trolley while the nurse dealt with the emergency. It was quite difficult to find staff to help during the inspection and this may occur during the medication round. In one instance the nurse on duty left two residents, with mental health issues, in the dining room unattended and told them to be careful of the heated trolley, as it was hot. Two unused bottles of eye drops were found in one trolley but nursing staff had signed to record these as administered. On further questioning the staff said these were due to be started today and the old bottles had been thrown away. The pharmacist inspector asked them to retrieve them from the clinical waste bin to be told they had been thrown away in the ordinary waste bin. This is of serious concern that clinical waste is being discarded inappropriately and in breach of the Hazardous Waste Regulations 2005 The nursing units all operate the same homely remedy policy but medicines purchased did not reflect the medicines the doctor had signed to say was acceptable to administer. Medicines that are no longer required are discarded in a clinical waste bin. The clinical waste company had not collected these unwanted medicines for some The Ridings DS0000067308.V326276.R01.S.doc Version 5.2 Page 21 time resulting in large quantities of medicines left on the premises. These had not been secured in a locked facility within the medication rooms. Nurses knowledge of the medicines they administer varied. Some were competent in this field whilst others did not know the basic reasons why medicines they handled were administered. The management team regularly undertakes routine audits. These had failed to find the issues raised during the inspection. The auditing process may have to be upgraded to ensure it correctly identifies shortfalls in the service offered. As recorded one care assistant was seen by the inspector administering a medicine to a resident. The care assistant pushed the tablet into her mouth using her finger. She subsequently fell asleep and the tablet was seen to sit on the lips. A Regulation Manager observed other poor practices on the Aintree residential unit; findings regarding health and personal care were as follows. The level of interaction was poor between staff and residents. Only two good staff interactions observed in over two hours . Several times residents tried to interact with staff and were ignored. Staff were heard referring to residents as she and he. Staff felt the clothes (assume to check if wet) of a resident; there was no explanation or communication with the resident. A residents legs were taken off a footstool and she was transferred to wheelchair, there was no explanation by staff of what was happening or what they were doing. (Observation period 11.15 am-1.15 pm;) at 1pm a resident was taken to the toilet in a wheelchair. When moved a pressure-reducing cushion was placed on the armchair where she had been sat all morning. A care plan states the resident should be sat on the cushion all the time Medication practices when administering were appalling. Staff placed medication in residents mouths with their fingers, usually no explanation of what they were doing, no hand washing seen although may of outside of observational area. Staff did not check that residents had swallowed tablets and in one case the medication was seen coming out of the residents mouth afterwards. One male resident asked staff where the toilet was, staff advised they would show him and were seen to take this resident by the hand and be several steps The Ridings DS0000067308.V326276.R01.S.doc Version 5.2 Page 22 in front. The resident was heard to say do you have to hold my hand and the comment was ignored. The lounge area was left unsupervised for quite a lot of the time. Whilst on Doncaster Unit the Regulation Manager observed that it was completely different. The majority of interaction from staff was positive or neutral. Staff made genuine attempts to interact with all residents and clearly knew individual preferences and interests. The Ridings DS0000067308.V326276.R01.S.doc Version 5.2 Page 23 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): Standards 12, 13, 14 and 15. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home has not demonstrated that it has the ability to provide its residents with a daily and social life that is individual, engaging and purposeful. This means that residents will often become bored and with a lack of stimulation will ultimately lose basic skills such as communication, abilities such as home life skills and also increase their loneliness. EVIDENCE: Practices were observed on the Aintree residential unit by a Regulation Manager, findings regarding daily life and social activity were as follows; Staff basically stood behind chairs or at the sink or not in the room watching, no attempts to engage with residents unless in direct care task. Loud pop music (Heart FM) on all the time observations made. Given the age of residents currently on the unit this appeared to be for staff benefit not residents, TV also on during the whole time with the volume low. The Ridings DS0000067308.V326276.R01.S.doc Version 5.2 Page 24 Several times residents tried to interact with staff and were ignored. Staff were seen feeding a resident who was very slight after staff had fed eight teaspoons the resident slowed down and staff asked if she had, had enough and the resident said yes so staff took the food away. No attempts were made to persuade the resident to eat more, or provide an alternative or come back in a few minutes to try again. This residents’ mouth was wiped with a napkin, no explanation was offered. Recent complaints have a lack of activity and stimulation in common. A recent response from the head of clinical governance stated that there is a range of organized activities available on each unit, which included domestic type arrangements such as light dusting etc. The activity co-ordinator arranges set activities. During the inspection on four units no organized activities were seen available to residents during the morning time in the communal areas, however the provider has commented that activities are available in the activity room away from the units and staff were seen often talking amongst themselves and not with residents. During the second day of inspection an organized activity was seen taking place during the afternoon, this was a board game on Aintree Unit. Each unit has its own activity file, details for three residents on Aintree Unit were seen however there was only one assessment of life interests and hobbies to help direct activity. For two residents activities were random and not based on a good assessment. Records for one resident began on the 16th October 2006, there were twenty-three entries over a period of three months, of which eight were hairdressing, there were some entries about parties, dancing and a ball game exercise. Another resident who had no assessment had records going back to 31st August 2006, records indicated that this resident had refused take part in many of the offered activities but did at times have her hair and nails done. Relatives and friends of residents who were interviewed at the inspection had a mixed experience of daily life and social activity in the home. One friend stated “he is bored” that he has lost his glasses and that hasn’t helped, that there is not enough exercise or stimulation however a relative described how his mother often goes out for walks when he visits, enjoys a social drink and takes exercise with staff. Two recent complaints detailed concerns about the quality of food, and food being left in front of a resident who is unable to feed herself. As recorded above on one day of the inspection a resident was not woken for her lunchtime meal and another resident was not adequately encouraged or provided with alternative nutritional meal at lunch. Residents’ assessments do often record what food they like and its preparation. The menus appear to be well balanced and there is a choice and where a need is identified records of what residents have eaten are maintained. The Ridings DS0000067308.V326276.R01.S.doc Version 5.2 Page 25 Residents often choose lunch from a menu of food each morning. On the day of inspection the meals being served did not fully correspond with the available menu. Staff record what the resident has chosen and this record is sent to the cook. Residents cannot always recall what they have chosen and often rely on staff and visitors to remind them. Relatives had mixed opinions about how they are valued, one relative felt that all staff were warm and included him in making decisions about his mother and that they were receptive to any comments he had to make; whilst another relative was of the opinion that staff did their best to avoid talking. The Ridings DS0000067308.V326276.R01.S.doc Version 5.2 Page 26 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): Standards 16 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has not demonstrated that it has the skills and processes to ensure complaints and issues about the protection of residents are effectively managed and that where there are clear indicators of poor outcomes for residents and that satisfactorily improvements are not being made. EVIDENCE: Since the last key inspection three complaints have been received at the Commission of which two were passed onto the home to investigate and respond and the Commission at this inspection investigated the third. One of the complainants has advised that a response was not received, the home say it was sent and another complainant felt that the complaint was poorly managed. The home does maintain a log of complaints and since August 2006 twelve have been recorded, details of the complaint, the subsequent investigation (where needed) and the response to the complainant were available. The amount of complaints relating to Aintree Residential Unit was discussed with the acting manager, whose opinion was that when the home first opened it took off to quickly, there was not enough staff, lots of agency staff were being used, she felt it should have been a phased process. She also felt that there was a lack of skills amongst the staff team and that they were poorly trained, The Ridings DS0000067308.V326276.R01.S.doc Version 5.2 Page 27 she mentioned that relatives need to be able to trust straight away and that if the trust is lost it is difficult to get back. When asked specifically why one unit Aintree, appeared to be failing to meet the needs of residents, and where detailed complaints had been focussed the manager responded by saying “people have been on the unit and think it is good” (referring to the clinical governance manager and registered person), the manager then agreed based upon some of the current findings that something was going wrong on this unit. Staff training files were sampled and evidence was available confirming they do attend training on adult abuse awareness. The manager has mostly responded quickly when concerned for the safety of a resident, she has sometimes notified the commission on Regulation 37 forms of incidents and concerns, she has also at times made referrals to Social Care and Health after discussing her concerns with social workers or with the Commission and the manager and the registered person have made themselves available to attend strategy meetings regarding adult protection when asked to attend. There have been occasions when the manager should have raised an adult protection referral, information found by another inspector who was inspecting a nurse agency detailed a possible assault by an agency health care assistant, the manager was aware of this and did not until contacted complete a Regulation 37 form or contact Social Care and Health. The Ridings DS0000067308.V326276.R01.S.doc Version 5.2 Page 28 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): Standards 19, 20, 21, 22, 25 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has not demonstrated that it provides residents with an environment that is safely maintained, fully accessible and well decorated to help meet their specific needs including recognition and memory impairment. This may mean that residents are not adequately supported to be independent and many areas are lacking sensory stimulation. EVIDENCE: Two inspectors undertook a tour of the six units, whilst one inspector was also able to assess the impact of the immediate environment on the care of residents, as specific periods of time were spent observing on two of the units. The focus was upon communal areas. The Ridings DS0000067308.V326276.R01.S.doc Version 5.2 Page 29 Communal areas being corridors, washing areas, toilets, dining areas and lounges were all warm. Some areas were excessively hot causing residents, staff and visitors to the home to be uncomfortably warm and for some residents this may mean they require additional fluids. There is a general infection control concern, as the inspectors were advised by staff that all domestic staff finish duty at 2pm, this may not be adequate cover and additional hours must be considered as concerns about finding spillages in bathrooms and toilets had been raised within one of the complaint. There were no untoward odours at the time of inspection which was a concern raised by a relative in the complaint. Aintree Unit. Was found to be tidy, however the décor in communal areas is very bland, doors tend to blend into walls and there are no features that may be of interest to residents as they walk up and down corridors and in and out of the dining and lounge areas. There are very few signs that will help direct and remind residents, such as to the toilet and on more than one occasion residents were seen walking the corridor looking for toilets and also for a supply of towels, their obvious needs were ignored by staff walking past. One resident then urinated in a corner of the corridor. Minor repairs included, • • • Fixing the thermostat to the radiator in the lounge area. Ensuring the shower room (SG2) has a non slip floor surface and that a shower curtain is fitted. The exposed wires of a light fitting are made safe, (this was left as an immediate requirement on the 16th January 2007, on the 19th it was found to have been repaired. Improving infection control, • • Ensuring continence aids (net knickers) are in residents rooms and not in the bathroom Ensuring towels and clothing (clean) are in residents’ rooms and not in bathroom. Cheltenham Unit. Was found to be tidy. As on Aintree unit décor is very bland and there are few signs to help direct residents about the unit, there are no areas of interest that may engage the residents and provide some stimulation whilst they walk about. Improving Infection Control, The Ridings DS0000067308.V326276.R01.S.doc Version 5.2 Page 30 • A full and overflowing clinical waste bag was still in use in the shower room, the drain filter was not in the drain and incontinence pads were being stored. There was a tablet of soap in use in the bathroom. Ascot Unit. Was found to be tidy. As on other units décor is very bland and there are few signs to help direct residents about the unit, there are no areas of interest that may engage the residents and provide some stimulation whilst they walk about. Minor repairs included, • • Repairing the wall in the dining area where the wheelchairs had damaged it. A window in the dining area opened very wide, there were restrictors but they were not working properly. Doncaster Unit. Was found to be tidy. As on other units décor is very bland and there are few signs to help direct residents about the unit, there are no areas of interest that may engage the residents and provide some stimulation whilst they walk about. Improvements are needed, • At the original site visit during registration assessment the registered person was asked to ensure that the activity room and dining room be accessible to residents, this has not been completed as both areas have a door that requires entry via a coded lock. Residents must have access to their communal areas. Champion Crescent Unit Gr and 1st floor. Was found to be tidy. As on other units décor is very bland and there are few signs to help direct residents about the unit, there are no areas of interest that may engage the residents and provide some stimulation whilst they walk about. Improving infection control, • Ensuring clean towels are stored in residents, rooms and not in bathroom. The Ridings DS0000067308.V326276.R01.S.doc Version 5.2 Page 31 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): All standards. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has not fully demonstrated that the staff who provide care and support to the residents are always available in adequate numbers, safely recruited, well trained and who are well supported. This may mean that residents needs are not effectively met and their health and welfare will be put at risk. EVIDENCE: Two of the complainants had raised concerns that at times very young care assistants were left on the Aintree unit to work alone and often worked with agency staff. There was no evidence from speaking to staff and checking rotas that staff had worked alone. However it was evident that some staff had worked with agency staff. A younger member of staff who had worked on Aintree unit with agency staff had her recruitment, training and supervision records checked, as were the records of another three staff. Staffing rotas for all six units were seen. Each unit has its own dedicated team of staff, however this does not prevent staff working on other units when this is needed or when additional staff numbers are required. There have also been complaints that the staffing levels on the Aintree unit are not high enough, and as identified by the Regulation Manager it was observed that the lounge where many residents spend much of their time was left unsupervised for a lot of the time. The Ridings DS0000067308.V326276.R01.S.doc Version 5.2 Page 32 Aintree unit (residential) normally has three staff on duty (all care assistants) 8am to 8pm, to maintain this level agency staff are sometimes needed. The rota on the day of the inspection included a care assistant who was also recorded as working on Ascot unit. Cheltenham unit (nursing) has an adequate number of staff to meet the needs of up to seventeen residents, including nurses, similarly on Ascot unit. However there were concerns on the day of inspection as on the morning and afternoon shift new members of staff were identified as undertaking induction, not including these staff there were three staff on duty 8am until 8pm when there needed to be at least four. Doncaster unit is residential and for the current residents two care assistants are available 8am to 8pm, this will need review should the needs of residents change or if there are additional residents; at night one care assistant is on duty supported by staff from Ascot unit. Champion Crescent has two units, for the current eleven residents there is one nurse and four care assistants on the morning shift and one nurse and three care assistants on the afternoon shift. These again will need to be revised should the needs of residents change or there are new residents. The manager for this unit confirmed that she would often work additional shifts or the home manager would book in agency staff, she also advised that the home manager was continuously trying to recruit new nurses. The focus of checking staff records was from the staff who work on Aintree Unit. Staff recruitment was seen from available records to be conducted safely, ensuring applications forms, interviews, references and CRB and POVA checks are made and completed. However it was a concern that on some application forms the nominated person for a reference had not always supplied a reference and that for at least one staff member the most recent employer had not provided a reference. The focus of staff training was for the staff who work on Aintree unit. The four training files seen indicate that the staff do receive some training. There were some records to show staff do undertake some safe working practices training and some service specific training; examples for some staff include health and safety, basic food hygiene, fire awareness, abuse awareness and medicines training. There are some gaps in training records whether this be safe working practice or service specific training. The main concern in the complaint was that some staff are too young, it was evident that some staff do not have the necessary experience, skills and competencies to take charge of the unit. For one member of staff who had taken charge she had many gaps in training including basic food hygiene, basic first aid, national vocational qualifications and dementia training. The second The Ridings DS0000067308.V326276.R01.S.doc Version 5.2 Page 33 main concern was that for a service, which provides care to residents with a dementia there was a lack of such training for all four staff. The home manager did provide a training programme for 2007, which included a programme for training staff in all safe working practices and recorded that dementia training in May and October 2007 was subject to confirmation. Relatives described some staff members as exceptionally pleasant and friendly, whilst others described them as turning up late for work, often caring but with little experience of care work. The Ridings DS0000067308.V326276.R01.S.doc Version 5.2 Page 34 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): Standards 31, 35, 36, 37 and 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home has not been able to demonstrate it has the current capacity to ensure that the home is managed and administered in an effective and safe way. Due to these serious concerns the health and well being of the residents is being put at serious risk. EVIDENCE: One relative described the home manager as being a supportive and helpful person with lots of advice when needed and supportive through the difficult period of their mother being admitted to the home. Other relatives said they had been made promises that the home manager never fulfilled such as The Ridings DS0000067308.V326276.R01.S.doc Version 5.2 Page 35 arranging domestic activity, that she was often not available when they visit and could be dismissive in her approach. The home manager has been previously adjudged as a fit person for registration and has been previously registered as a manager with the Commission and she is a trained nurse. She has recently submitted an application to be the registered home manager of The Ridings; the Commissions regional Central Registrations Team is determining this application. Since this inspection the regulation inspectors have been informed that the home manager has successfully completed the process of registering with the Commission. Each unit has a manager who reports directly to the home manager, it was not always clear how effective communication was in the home and how the home manager receives a daily handover and spends time on each unit making herself available to residents, relatives and staff; It is recommended that additional support through the role of deputy manager be considered to assist in the day to day running of all units. The home manager had been in post five weeks at the time of the last inspection, since this time there have been some improvements against the requirements issued at that inspection. However some were not met and there are many more requirements that need to be addressed quickly to improve outcomes in many areas for residents including their health. It was disappointing that following complaints by relatives from Aintree unit that the home manager did not realise there was and is some serious concerns on this unit. Quality assurance systems and audits was not assessed at this inspection. The home does manage some money and valuables for residents. Several concerns were made about the loss of belongings in general conversation with relatives and concerns were detailed in two complaints. This often included loss of glasses, dentures, hearing aids, clothing, jewellery and also damage to clothing. One relative felt it was partly the families’ fault as they had not labelled clothing and another visitor stated she now takes some items of clothing home as the whites often become stained. One relative in a complaint stated that she had provided quotes for replacement glasses but the home have not responded and also that the clasp of a broach had been broken off and there was no explanation for this from the home. Two inspectors found a basket in the laundry area containing the belongings of residents, in the box were belts, glasses, dentures, combs and watches; the laundry assistant advised that many items come to the laundry in pockets or are in red alginate bags that are not opened but with white laundry bags you can have a quick check. The residents are also provided with a safe keeping service for their money, how this was managed for three residents was seen. Records were well maintained and accurately balanced, the money available was correct and all The Ridings DS0000067308.V326276.R01.S.doc Version 5.2 Page 36 transactions had been signed by at least two members of staff. Where the home had made purchases on behalf of residents such as for hairdressing and toiletries appropriate receipts were available. Records for staff showed that three of the four staff had received supervision and or appraisal. The fourth member of staff had only recently commenced employment. The frequency of supervision was seen to be ad-hoc and for one member of staff she had only had one supervision meeting in the six months of her employment. Areas covered in supervision included working practices, philosophy of care, career development and further issues. It was a concern that the Commission had not always been notified of concerns about the well being of residents; the residents files were only sampled yet reports about a resident leaving the home for a short period, spending time with another resident in the bedroom described as “going to bed with __” and punching another resident were not reported under Regulation 37. Daily records for a resident involved in some of the above incidents were not available for a period of almost three days. Maintenance records were provided for inspection and found to be well maintained including; passenger lift safety, fire safety, electrical, water and gas safety. Staff do attend fire drills and records are available however it is not possible to determine whether staff attend two each year. An environmental health officer visited the home in September 2006 and raised some areas of improvement ,which the home manager states were all addressed. There was evidence that the home has the required liability insurance. Immediate requirement were issued on the 16/1/07,as there was a loose light fitting in the bathroom on Aintree residential unit, when the inspection continued on the 19/1/07 it had been repaired. Health and Safety issues on Aintree residential unit and other areas included; • • Two inspectors went into a residents’ room on Aintree unit and activated the call system on two occasions, staff did not attend the call. On Aintree unit the inspectors asked staff for the master key that is used to access residents rooms in an emergency and it was not available, one member of staff advised that other units had loaned it and it had been lost. On Aintree unit there is a Quiet room, which has bolts on the outside of the door. On Aintree unit in the bathroom was a bag of pink gel (liquid soap) with the label torn off. The laundry store area had the fire door wedged open. DS0000067308.V326276.R01.S.doc Version 5.2 Page 37 • • • The Ridings 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 2 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 1 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 2 3 1 X X 2 2 STAFFING Standard No Score 27 2 28 2 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X X X 1 2 2 1 The Ridings DS0000067308.V326276.R01.S.doc Version 5.2 Page 38 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation Requirement Timescale for action 31/03/07 2 OP3 5(1)(d)(2) The registered person must ensure that all prospective and current residents and their representatives e.g. relatives are provided with a written service users guide and include a copy of the most recent inspection report. 14(1)(a)( The registered person must b)(c)(d) ensure that the pre admission assessment of residents is comprehensive covering the needs of the resident and enabling clear and concise care planning. If the registered person then agrees that the needs can be met then this must be confirmed in writing to the residents that having regard to the assessment that the care home is suitable for the purpose of meeting their needs in respect of health and welfare. 16/03/07 The Ridings DS0000067308.V326276.R01.S.doc Version 5.2 Page 39 3 OP7 15(1) 12(4)(a) 4 OP7 15(1) The registered person must ensure that care plans are drawn up with the involvement of residents or where needed their representatives and comments such as “has flirtatious periods” are not used to detail the behaviour of residents with a cognitive impairment. The registered person must ensure that all residents have care plans written that are clear and concise and which enable staff to meet the assessed needs of residents. The care plans must be reviewed at least on a monthly basis. Previous timescale of 31/10/06 was not met, this requirement is carried forward. The registered person must ensure that residents who require use of aids such as glasses and hearing aids wear them where needed and if lost that they are quickly replaced. The registered person must ensure that staff follow the written care plans so residents do receive the care they need, for example wearing hearing aids. The registered person must ensure that the residents who require pressure relieving equipment due to prevention or treatment of pressure sores are fully supported to use them. 30/04/07 30/04/07 5 OP8 12(1) 31/03/07 6 OP8 12(1) 13(4)(c) 28/02/07 The Ridings DS0000067308.V326276.R01.S.doc Version 5.2 Page 40 7 OP8 12(1) 15(1) 8 OP8 12(1)(2)( 3)(5) 9 OP9 13(2) The registered person must ensure that the moving and handling assessments and a falls assessments include how the residents’ mobility is supported including resources, manoeuvres and staffing. The registered person must ensure that they act quickly and responsible to promote and make proper provision for the health, welfare and treatment of residents. All prescriptions must be seen prior to dispensing, checked and a system installed to check the dispensed medicines and MAR charts received into the home. Staff must check all new service users medicines brought into the home to confirm they are their current drug regime. This requirement was not met from the previous pharmacist inspection. Timescale 14/09/06 The MAR chart must be referred to before any administration and signed directly after each transaction or the reason for non-administration recorded. They must accurately reflect exactly what has occurred. The right medicine must be administered to the right service user at the right dose at the right time as prescribed by the doctor. This requirement was not met from the previous pharmacist inspection. Timescale 14/09/06 16/03/07 28/02/07 18/02/07 10 OP9 13(2) 18/02/07 The Ridings DS0000067308.V326276.R01.S.doc Version 5.2 Page 41 11 OP9 13(2) Sch 3(3)(i) The MAR chart must record the name of the service user, start date, drug name for all prescribed medicines, correct dose and the quantities of all medicines received and balances carried over to enable audits to take place to demonstrate staff competence in medicine management. This requirement was not met from the previous pharmacist inspection. Timescale 14/09/06 Any medicine prescribed to be administered on a when required basis must have supporting protocols detailing their use. All medicines must be administered from a pharmacist labelled container 18/02/07 12 OP9 13(2) 18/02/07 The Ridings DS0000067308.V326276.R01.S.doc Version 5.2 Page 42 13 OP9 13(2) 23(2)(l) All medicines must be stored in 18/02/07 compliance with their product licences, at the correct temperature. The installation of air conditioning systems may be required to achieve this. Medicines requiring refrigeration must be appropriately stored and professional advice sought if they are not. The position of the residential medication trolley must be reviewed to ensure medicines are stored at the correct temperature. The storage of medicines must be reviewed. Adequate cabinets must be purchased and installed to securely hold medicines in the home. This includes medicines awaiting return to the clinical waste company for destruction Medication trolleys must be of suitable size to safely store all the medicines prescribed within. All secure storage facilities must be able to be locked in the event of an emergency. All clinical waste must be disposed of appropriately to conform with current legislation (Hazardous Waste Regulations 2005) All confidential information must be securely held and not be kept in a public place accessible to people who are not at liberty to see it in line with current legislation (Access to Health Records Act 1990) 14 OP9 13(2) 18/02/07 15 OP9 13(2) 18/02/07 The Ridings DS0000067308.V326276.R01.S.doc Version 5.2 Page 43 16 OP9 13(2) 24(1) The manager must undertake staff drug audits before and after a medicines round to confirm staff competence in medicine management and appropriate action must be taken if these fail. This requirement was not met from the previous pharmacist inspection. Timescale 14/09/06 Further audits must be devised to ensure that staff are correctly monitored and identify any shortfall in standards. All dose changes must be supported by written evidence from the doctor. Enough medication must be ordered to last the 28-day cycle. Any further supplies must be sought in time so the service user has a continue supply of medication and does not go without prescribed medication All policies and procedures for medication must be reviewed and staff trained to adhere to them. Protocols for “when required” medication must be written detailing their use in conjunction with a clinician. Further training must be given to all staff in the safe handling of medicines to ensure that all medication is given in a way that maintains the service users dignity and well being. 18/02/07 17 18 OP9 OP9 13(2) 13(2) 18/02/07 18/02/07 19 OP9 13(2) 18/02/07 20 OP9 13(2) 18/02/07 21 OP9 13(2) 12(4)(a) 18(1)(c) 18/02/07 The Ridings DS0000067308.V326276.R01.S.doc Version 5.2 Page 44 22 OP9 13(2) 18(1)(c) All staff must receive further training if necessary so they can demonstrate they know what the medicines are for and basic side effects in line with their professional guidelines (for nurses) and skills for care knowledge sets (for care assistants). This requirement was not met from the previous pharmacist inspection. Timescale 14/12/06 The registered person must ensure that staff approach and treat residents with care and respect ensuring they always promote the dignity of residents and do not take actions, which are rude and undignified. The registered person must ensure that all residents have their daily life and social activity abilities and needs assessed and that either a care plan or programme of activity are individually implemented that are clear, concise and informative for staff. The registered person must ensure that there are adequate resources including numbers of skilled staff available to support residents with their daily life and social activity needs. Previous timescale of 31/10/06 was not met, this requirement is carried forward. 18/03/07 23 OP10 12(3)(4)( 5) 28/02/07 24 OP12 16(2)(m)( n) 31/03/07 The Ridings DS0000067308.V326276.R01.S.doc Version 5.2 Page 45 25 OP12 16(2)(n) 18(1)(a) 26 OP14 12(2) 27 OP15 16(2)(i) The registered person must ensure that residents have opportunities to engage in daily life and social activity that this is instigated in a positive way by staff and that staff take an interest in residents and do not exclusively communicate with each other. The registered person must ensure that residents are able to make their personal choices, be kept informed and staff must always ask residents and describe how they are being assisting with all areas of their care, including for example mobility and movement, television and personal care. The registered person must ensure that residents receive a varied, appealing, wholesome and nutritious diet, which is suited to individual, assessed and recorded requirements, and that meals are taken in a congenial setting and at flexible times. The registered person must ensure staff have the skills and competencies to deliver this. The registered person must ensure that a complainant does receive a response about the findings of the complaint investigation as detailed in the complaints policy. The registered person must ensure that all untoward incidents regarding the health, safety and welfare are reported to the Commission, And Notify Social Care and Health when the nature of such an incident is reportable under adult protection policy. DS0000067308.V326276.R01.S.doc 31/03/07 16/03/07 28/02/07 28 OP16 22(4) 31/03/07 29 OP18 13(4) 28/02/07 The Ridings Version 5.2 Page 46 30 OP19 31 OP20 32 OP22 33 OP25 34 OP26 35 OP27 23(2)(b)(c The registered person must ) ensure that the minor repairs identified in the body of the report are completed and undertake its own regular audit of maintenance and repair and where needed make good any concerns. 23(2)(e)( The registered person must g) ensure that all residents have access to shared facilities (including dining and activity rooms) and that this is only considered to be restricted as part of an individual risk assessment 23(2)(a) The registered person must 16(2)(n) ensure that there are improvements made to the communal areas of the home to provide residents with signs and other triggers to aid communication and recognition. 23(2)(p) The registered person must ensure that all residents and visitors live in a comfortable environment including having the facilities to effectively alter the temperature of the home. 13(3) The registered person must ensure that the infection control issues identified in the main body of the report are completed and undertake its own regular audit of infection control practices and if needed make necessary improvement. 18(1)(a) The registered person must 13(4) ensure that there are adequate 12(1) numbers of staff available to meet all the needs of residents, including daily life and social needs. Residents must not be left unattended for significant periods of time. 30/04/07 31/03/07 30/04/07 28/02/07 31/03/07 28/02/07 The Ridings DS0000067308.V326276.R01.S.doc Version 5.2 Page 47 36 OP27 18(1)(a) The registered person must ensure that staff are fully skilled, experienced and competent to undertake their roles and responsibilities including those of on-call and also when in charge of a unit. Previous timescale of 31/12/06 was not met, this requirement is carried forward. The registered person must ensure that a minimum of 50 of the care staff are qualified to at least NVQ level in Care. Requirement carried forward as timescale not up at time of this key inspection. The registered person must ensure that relevant checks are made for all potential new employees including a reference from the most recent employer and this should be gained from a senior person. The registered person must ensure that all staff receive appropriate training for the work they are to perform. This must include a full induction based upon Skills for Care units, all safe working practices and training relevant to the specific needs of residents; this must include for some staff a basic awareness of dementia care. Previous timescale of 31/12/06 was not met, this requirement is carried forward. 30/04/07 37 OP28 18(1)(c)(i ) 30/06/07 38 OP29 19(1)(c) para 5 Schedule 2. 28/02/07 39 OP30 18(1)(c)(i ) 31/05/07 The Ridings DS0000067308.V326276.R01.S.doc Version 5.2 Page 48 40 OP35 13(6) 12(1) 41 OP36 42 OP37 43 OP38 44 OP38 45 OP38 The registered person must ensure that there are effective and safe systems to protect the belongings and valuables of the residents. Where there has been damage or loss of property then timely adequate measures must be taken to replace such items. 18(2) The registered person must ensure that care staff are well supported and do receive regular formal supervision. 17(1)(a) The registered person must schedule ensure that all records required 3. by regulation including individual care records are secure upto date and in good order. Missing daily reports must be located and safely securely stored. 37(1)(2) The registered person must ensure that accidents and incidents in the home that have an effective on the health and or well being of residents are reported to the Commission without delay. 13(4) The registered person must ensure that when the call bell is activated that staff respond quickly. 13(4) The registered person must 23(4)(c)(ii ensure that a master key is i) available on all units to allow staff access to all rooms in an emergency. 28/02/07 30/04/07 28/02/07 28/02/07 28/02/07 28/02/07 The Ridings DS0000067308.V326276.R01.S.doc Version 5.2 Page 49 46 OP38 13(4) The registered person must 23(4)(b)(c ensure that all fire doors are )(i) maintained so that they will close if the fire system is activated. The registered person must ensure that all COSHH products are securely stored. The registered person must ensure that bolts are removed from the outside of the quiet room door on Aintree unit The registered person must ensure that records are available of which staff have attended fire drills and ensure they attend at least two drills annually. 28/02/07 47 OP38 23(4)(e) 31/03/07 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 Refer to Standard OP9 Good Practice Recommendations All homely remedies must be purchased and be administered against a homely remedy policy that is appropriate for the staff group responsible for their administration. It should detail medicines the home wishes to purchase only. It is recommended that the registered person consider how residents currently choose their meals and make appropriate improvements. It is recommended that domestic hours be extended and that all staff who see a spillage take responsibility for ensuring it is quickly cleared. It is recommended that a suitable, experienced and competent deputy manager be employed to provide support to the managerial, residential and clinical nursing team 2 3 4 OP15 OP26 OP31 The Ridings DS0000067308.V326276.R01.S.doc Version 5.2 Page 50 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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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