Inspection on 23/06/08 for The Shires

This inspection was carried out on 23rd June 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Shires 19/05/09

The Shires 29/11/08

The Shires 04/07/06

Extracts from inspection reports are licensed from CQC, this page was updated on 09/11/2008.

CARE HOMES FOR OLDER PEOPLE The Shires 12 - 13 Gorringe Road Eastbourne East Sussex BN22 8XL Lead Inspector Gwyneth Bryant Unannounced Inspection 07:30 23rd June 2008 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Shires DS0000067518.V365551.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 Shires DS0000067518.V365551.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Shires Address 12 - 13 Gorringe Road Eastbourne East Sussex BN22 8XL 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) 01323 721032 01323 646771 christineb66669@aol.com Eaglecrest Care Management Ltd Vacant Care Home 27 Category(ies) of Dementia - over 65 years of age (27) registration, with number of places The Shires DS0000067518.V365551.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The maximum number of service users to be accommodated is twenty-seven (27). Service users must be older people aged sixty-five (65) years or over on admission. Service users with a dementia type illness only to be accommodated. Date of last inspection 4th July 2006 Brief Description of the Service: The Shires is a care home registered to provide accommodation and care for twenty seven (27) older people with a dementia type illness. The home is situated in a residential area of Eastbourne, nearly two miles from the town centre. The Shires provides twenty four (24) single rooms, fourteen (14) with en-suite toilet and hand basin facilities and three (3) double rooms. There are two assisted baths and two assisted shower facilities. The home provides several communal areas, including a conservatory and a large accessible rear garden. There is a stair lift to access the first floor accommodation. Prospective residents are given a copy of the home’s brochure and they can find out information about the services and facilities at The Shires via the internet on Carefinders. The range of fees charged as from 1 April 2008 is from £473 to £673 and in-house activities are included in the fees. Additional charges are made for hairdressing, toiletries, chiropody, newspapers and dry cleaning. Intermediate care is not provided. The Shires DS0000067518.V365551.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This was an unannounced inspection and took place over seven hours. The purpose of the inspection was to check compliance with the requirements made at the last inspection and check key standards. Twenty-five people were in residence on the day of which four were spoken with. The Deputy Manager, one member of staff, the cook and two visitors were also spoken with during the site visit. A tour of the premises was carried out and a range of documentation was viewed including care plans, personnel and medication records In the absence of a manager the Deputy Manager facilitated the site visit and was available to answer any queries. An Annual Service Review was carried out in March 2008 and as a result of that review we changed our inspection plan to carry out a site visit before 1 July 2008. Prior to the site visit we asked the Registered Providers to complete an Annual Quality Assurance Assessment (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. This was provided and the information included in this report as necessary. What the service does well: What has improved since the last inspection? Of the three shortfalls identified at the last inspection two remain outstanding in respect of all new staff being provided with an induction period that meets the Skills for Care guidance and that a staff training audit is carried out. However, the requirement relating providing staff with regular supervision had been met. The Shires DS0000067518.V365551.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Shires DS0000067518.V365551.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Shires DS0000067518.V365551.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 4 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Improvements need to be made to the admission assessment to demonstrate the needs of people moving into the home can be met. EVIDENCE: The pre-admission sheets four people were viewed and while they identified needs, they did not include information as to how the home will meet those needs and not all parts of the document had been completed. Two of the pre admission documents had just one or two words to identify care needs and therefore there is a lack of detail. In addition not all sheets were signed and dated so it was not possible to track who had carried out the assessments and when. These shortfalls do not give sufficient direction to staff in meeting the needs of people newly admitted to the home. Intermediate care is not provided. The Shires DS0000067518.V365551.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. All aspects of service users health, welfare and care must be identified and planned for, in order to clearly direct staff in the delivery of appropriate care. Improvements to all aspects of the administration in medication need to be made to ensure people living in the home are not at risk. EVIDENCE: Four care plans were viewed in conjunction with daily notes, medication charts and risk assessments. While the plans identified most care needs, information often consisted of a single sentence or not completed at all. It is important to ensure full details of how needs are to be met are recorded as a point of reference for staff. Where risk assessments were in place they did not include action staff need to take to reduce the risk and the reviews of risk assessments were marked as ‘no change’ even though two people had begun to have more frequent falls. One persons care plan had been written in April 2007 and although the daily notes indicated that this persons needs had changed considerably the monthly reviews had been written as ‘no change’. It is crucial to ensure that all records relating to care needs accurately reflect current needs. The Shires DS0000067518.V365551.R01.S.doc Version 5.2 Page 10 The service has identified one person as needing nursing care due to his frailty and high number of falls but their family have been unable to find a suitable home. It is vital that people living in a care home have staff who can meet their needs and therefore this situation needs to be reviewed. Following the site visit the Registered Provider confirmed that this person has now left the home. The lack of regular reviews is evidenced in other parts of the report which highlights that changes in needs are not identified in an appropriate manner. Daily notes were variable with some providing good information on how people spent their day but others consisted of comments such as ‘had a good day’, ‘slept well and no problems’. It is important to ensure that all daily records relating to care give a good indication of how people spent their day in order to inform the review process. It is these daily notes and accident records that show some people have begun to have falls and are aggressive towards others. However, care plans have not been updated to give staff direction on what action to take to reduce these risks therefore outcomes are poor as people remain at risk. Care plans showed that some people needed eye/hearing tests but there did not appear to be follow up notes to demonstrate whether or not they had been carried out nor who was responsible for doing so. Following the site visit the Registered Provider confirmed that all people living in the Shires have annual eyesight tests. The lack of regular reviews is evidenced by the failure of the home to promptly identify people whose needs put them outside of the homes registration category. This shortfall was identified as a result of a safeguarding adult investigation carried out in June 2007. People living in The Shires are weighed regularly and it was clearly noted those people who need assistance with meals and whether or not they need supplements, however it would be an improvement if general dietary advice were sought as a number of people living in The Shires were of low weight. Following the site visit the Registered Provider confirmed that each person now has an annual dietary assessment. Medication Administration Records (MAR) were viewed and there were a number of gaps and some signatures had been scribbled out which suggests staff sign the charts prior to administration. There were notes on some charts identifying who had failed to sign the MAR. However, staff did not follow good practice in respect of medication as they were seen to sign the MAR charts for more than one person at a time and to sign prior to medication being administered. A carer was seen to take medication to two people at the same time and for one person this same carer did not wait to see if they took their medication. Any medication that is refused is stored in an envelope with the name of the person who refused and the medication. However, there were two envelopes containing tablets that had been found on the floor of the lounge The Shires DS0000067518.V365551.R01.S.doc Version 5.2 Page 11 which suggests that staff do not observe people taking their medication but sign to say it has been administered. A carer was seen to take three pots of medication for two different people; one set of medication was signed for prior to being administered but the other was not as the recipient was known to refuse medication regularly. Given that the home has notified the CSCI of three medication errors, whereby individuals were given tablets intended for someone else or given a higher does, it is important for all staff to closely follow guidance on the safe handling of medication. The medication errors were discussed with the Deputy Manager who explained that she was unable to determine how the errors occurred but following the errors the correct procedure was followed with GP’s being contacted for advice. The Shires DS0000067518.V365551.R01.S.doc Version 5.2 Page 12 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): People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The lifestyle experience by people living in the home does not match their expectations, choice or preferences. Meals are satisfactory but the breakfast menu needs to be adhered to. EVIDENCE: A carer has been employed to provide activities some mornings and again from 2-4pm however, not all of the people in the home are able to take part in the activities and a number were left sleeping in the lounge chairs for a large part of the day. There needs to be a planned programme of daily activities, based on the preferred leisure interests of people living in the home to ensure people have something to do during the day. Visitors spoken with and in the returned surveys the lack of stimulation and activities was mentioned. The Deputy Manager brings her dog to the home and it appeared that people living in the home welcomed the opportunity to pet and stroke it. At the start of the visit it was noted that fourteen people were up and dressed. Discussion with the senior carer on duty found that everyone must get up by 8am, as that is when breakfast is served. Further discussion with both the senior and the Deputy Manager found that people are not given a drink or food on rising even though some get up at 5.30am, however the senior carer said The Shires DS0000067518.V365551.R01.S.doc Version 5.2 Page 13 they would be given a drink if they ask. Due to their dementia few people are able to ask for a drink or express hunger. On the day of the visit no one had any food until breakfast at 8.15 and tea was not served until approximately 8.30am. It is crucial to ensure people are encouraged to have a drink and something to eat on rising to ensure good nutritional intake. This matter was discussed with the Deputy Manager who agreed that it would be less of a rush if people were given breakfast when they wanted it rather than a set time. A change in practice would also be move towards a more person centred care regime, as currently it is task orientated. It was good to note that a choice of three different fruits were offered at breakfast however, some people were given jam/marmalade sandwiches for breakfast but there was no indication in their care plans that demonstrated they had chosen this for breakfast. The chef brought an uncovered tray of toast into the staff room and it was left on the trolley for 22 minutes before being served, therefore it was cold and this needs to be addressed. One person does have breakfast served in their room but on the day it was left on the table bedside the bed, as they were asleep. It was of concern that a hot pot of tea was left in a bedroom, as there was no risk assessment to suggest it was safe to do so. Breakfast was discussed with the chef and he was asked if anyone was ever offered a cooked breakfast and he replied that they were not and usually people were given whatever was recorded when they were admitted. Later discussion with the Deputy Manager found that this was not correct but no one was asked what they would like for breakfast on the day and there was no indication that anyone is offered a cooked breakfast. Whilst in the office a carer was heard to shout to a lady going to the toilet ‘don’t forget its skirt up and knickers down’. Shouting out such things and the lack of choice over meals seriously impinges on the dignity, privacy and autonomy of people living in the Shires and needs to be addressed without delay as any verbal prompts need to be given discreetly. Assistance with eating was varied with one carer demonstrating good practice to encourage a reluctant eater but another instance found that a carer did not assist in a manner that was encouraging and in line with good practice. The chef did say he is happy to do a meal not on the menu if required so choice is available if offered. Currently alternative meals are not routinely on the menu and discussion with the chef and Deputy Manager found that they had been working on this but it would need to be put on hold as the Deputy Manager said she would not be able to implement it as the chef is leaving. The chef agreed that he has never been asked to provide a cooked breakfast or fortify meals with more calorific items such as butter or full fat milk. There is clear evidence that the home tries to meet the government guidelines of five pieces of fruit/vegetables each day. The Shires DS0000067518.V365551.R01.S.doc Version 5.2 Page 14 Care plans did not include full details of preferred leisure interests and daily routines therefore it was not possible to ascertain whether or not the activities provided were based on individual preferences. Following the site visit the Registered Provider said that there are records of activities for each person but this was not available on the day. Some people do go out with family or talk walks in the garden when the weather is good but other activities remain limited. Visitors spoken with said that staff were welcoming and kind. The Shires DS0000067518.V365551.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. There is a satisfactory complaints procedure but improvements need to be made to ensure staff are familiar with current adult protection systems EVIDENCE: Information in the AQAA indicated that there are detailed policies and procedures on both complaints and Protection of Vulnerable Adults. All complaints are dealt with in accordance with the homes policies and procedures. People spoken with felt they could talk to anyone if they had any concerns about the care given. Staff training records show that not all staff have received up to date training in safeguarding adults. It is imperative that this addressed without delay as staff practices in respect of manual handling put people at risk and the homes routines show that people living in The Shires have limited choices over their daily lives. Four allegations of abuse have been made since the last inspection and all were investigated. None of the allegations were fully substantiated but recommendations were made as a result of an investigation by East Sussex Social Services in respect of one allegation in that staff training in manual handling be provided and reviews of service users showed that two were in need of nursing care. The Shires DS0000067518.V365551.R01.S.doc Version 5.2 Page 16 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): People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Most parts of the home are well maintained and homely but improvements need to be made to both the environment and infection control practices. EVIDENCE: A tour of the premises was carried out and a number of randomly selected bedrooms inspected. Most parts of the home are maintained and décor is generally good, with individual bedrooms being attractively decorated and comfortable. It was of concern that when the inspector entered one room an under carpet pressure mat bell was triggered but staff did not respond even though the care plan for the occupant stated that the pressure mat was in place due to frequent falls. Although the home was mostly clean, tidy and well maintained a number of shortfalls were found that detract from the generally attractiveness of the home and these were: • A fire door was wedged open with a chair. The Shires DS0000067518.V365551.R01.S.doc Version 5.2 Page 17 • • • • • Talcum powder in one room that did not belong to the occupant. In one communal toilet both the liquid soap and paper towel dispensers were empty. One bedroom was malodorous as was the landing outside certain rooms. Wheelchairs in the shower room did not have footplates. Some rooms/en-suite facilities did not have waste bins. False teeth were found in two rooms so the owners may have had problems eating without them. However, following the site visit the Registered Provider confirmed that one of the owners of the teeth leaves one pair in their room as it is a spare pair and the other does not always use them. Although the laundry facilities are good and washing machines are able to wash clothes at temperatures that reduce the risk of cross infection, staff practices increase the risk of infection. One member of staff was seen to be cleaning a toilet but not wearing an apron, thus their uniform would be splashed, soiled trousers and underclothes were left in a communal bath rather than being bagged up and taken to the laundry room even though the odour suggested that they were soiled with faeces. Another carer was seen to be assisting an individual on the toilet and although she was wearing gloves she was not wearing an apron. Staff were also seen to handle soiled bed linen without wearing gloves and aprons. These practices puts people living in the home, staff and visitors at risk of infection. These practices need to be given urgent attention especially as the home has had an outbreak of both a streptococcal infection and scabies since the last site visit. Following the site visit the Registered Provider confirmed that infection control training is included on the staff annual training programme. The Shires DS0000067518.V365551.R01.S.doc Version 5.2 Page 18 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): People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. There are sufficient staff to meet the needs of people living in the home and recruitment practice is robust, however improvements need to be made to all aspects of staff training. EVIDENCE: The staff rota showed that three staff on duty for each daytime shift and two at night, in addition to the Deputy Manager. The home also employs cooks, general assistants and housekeepers. However, the Deputy Manager said she sometimes has to do the cooking in order to give the chef a day off and she is not sure whether or not the other chef will be able to work extra hours when the main chef leaves at the end of June 2008. Staff records were viewed and the two new staff whose recruitment records were viewed had not completed their induction training in line with the Skills for Care guidance. New staff need to be made familiar with the care practices of the home and have the opportunity to assimilate policies and procedures relating to their work. Currently there is a total of 13 care staff of which 7 either has or is working towards National Vocational Qualification level 2 in care. Of these three have achieved National Vocational Qualification at level 3, therefore the home is on target to exceed the required 50 of care staff with this qualification. Discussion with the Deputy Manager found that the home is behind on its staff training schedules with a number of staff needing updated training in manual The Shires DS0000067518.V365551.R01.S.doc Version 5.2 Page 19 handling, fire safety, first aid, infection control, and Safeguarding Adults. Staff practices on the day of the site visit shows that until this training is provided and put into day to day practice people living in the home are at risk. On viewing the staff training matrix it appears that there are 10 care staff and the Deputy Manager said this needs to be updated to accurately reflect current staffing levels of 13 care staff. The AQAA provided in October 2007 indicates that there are 15 care staff and 8 other staff members therefore it appears that staffing levels have fallen. Recruitment records for the last two people employed were viewed and it was clear that they had provided the required documentation prior to starting work. All had two written references, Protection of Vulnerable Adults and Criminal Records Bureau checks. These recruitment practices reduce any risks to those people living in The Shires. The Shires DS0000067518.V365551.R01.S.doc Version 5.2 Page 20 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): People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staff need to be provided with sustained leadership and direction and systems need to be put in place to ensure all aspects of service users health, welfare and safety are protected and promoted. EVIDENCE: It is of concern that there have been four managers since 2005 with the Deputy Manager taking on the role of manager when the post is vacant. Of those four managers only one was registered with the CSCI. The frequent manager changes have led to a lack of direction and leadership for staff which leads to a poor outcomes for management overall. The Deputy Manager has been in charge of the home since the last manager left in February 2008 but has not been allocated specified management hours. Although she is knowledgeable, experienced and has an National Vocational Qualification level 3 in care, it is not possible for her take on the role of The Shires DS0000067518.V365551.R01.S.doc Version 5.2 Page 21 manager and to be able to continue to fulfil her Deputy Manager role to oversee day to day staff practice. The high number of shortfalls identified during the site visit evidences this and discussion with the Deputy Manager found that successive managers have implemented different staff training and care practices so it has been difficult to sustain a good quality service. As the home has always operated with both a Manager and Deputy Manager in post it is clear that there is a need for both posts to be filled as the home cannot function effectively with just one person trying to do both roles. The home does not handle the finances of anyone in the home; any items provided are receipted and added to the monthly invoice. Currently there is the option for staff to collect the pension for one person but a decision has been made not to do so and the preferred option is for this function to be carried out by someone from the placing authority. The CSCI received information in 2007 in respect of hoists not working and stair lifts unsafe. These were unsubstantiated and the Deputy Manager confirmed that all hoists and stair lifts were in good working order. During 2007 the home notified the CSCI of service users leaving the premises, which shows that staff are not directed in respect of supervising people in the home therefore they are at risk. As with assisting with meals, staff practice was variable in respect of manual handling with some staff seen to ignore good practice as on two occasions during the visit they were observed to assist people out of chairs by lifting them under their arms. On two other occasions staff followed good practice in using the lifting belts provided. The poor practice puts both staff and the individual at risk of injury. The reports from visits by the Registered Provider were available for inspection with one dated 02/03/08 as the date of the visit and 21/12/07 for the date of the report. This report named the home as Wyndham House; therefore it was not clear which home the report referred to. Reports resulting from the Registered Provider visits need to available for inspection as required. It is of concern that the fire risk assessment carried out in October 2006 identified a number of fire risks including the fitting of self-closing devices to all doors that require them and an alternative solution to locking the front door and storing the key in a nearby cupboard. The East Sussex Fire and Rescue Service visited in the home in March 2007 and made a number of recommendations including some that were identified in the October 2006 report. The Registered Provider said all recommendations in the report had been addressed. However, on the day there were a number outstanding as follows: • Some fire doors did not close fully. The Shires DS0000067518.V365551.R01.S.doc Version 5.2 Page 22 • • At the start of the site visit the fire door leading to the small kitchen was wedged open with a towel making the self-closing device ineffective in the event of fire. A bedroom door was wedged open with a chair. Each of these shortfalls puts people living in the home, staff and visitors at risk in the event of fire as does the failure to ask visitors to sign in and out of the home as the inspector was not asked to do so at the start of the visit. The accident records were viewed and there have been a number of falls, mostly early morning or late evening and a review of staff deployment at these times needs to be carried out to reduce the risk. The Shires DS0000067518.V365551.R01.S.doc Version 5.2 Page 23 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 X X 2 2 X N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 1 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 X X 2 The Shires DS0000067518.V365551.R01.S.doc Version 5.2 Page 24 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 OP4 Regulation 14 (1) (d) Requirement That the pre-admission document be expanded to include information as to how the home will meet assessed needs and are signed and dated. That all service users have a completed care plan and that all plans are regularly reviewed to accurately reflect current care needs. Risk assessments undertaken for those at risk of falls and tissue breakdown must include the management of the risk and be regularly reviewed. All staff who administer medication must receive satisfactory training and follow it in practice and that all medication administration records are clear accurate and up to date. That the home is conducted to ensure the dignity of service users is protected and promoted at all times. That a planned programme of activities based on service users interests be devised and DS0000067518.V365551.R01.S.doc Timescale for action 23/09/08 2 OP7 15 (1) (2)(b)(c) 23/09/08 3 OP7 13 (4) (b) (c) 23/09/08 4 OP9 13(2) 18 (1)(a)(c) (i)(ii) 23/09/08 5 OP10 12 (4) (a) 23/09/08 6. OP12 16 (2)(m)(n) 23/09/08 The Shires Version 5.2 Page 25 7 OP14 8 9 10 OP15 OP18 OP26 11 OP33 12 13 OP26 OP30 14 15 16 17 OP30 OP31 OP38 OP38 implemented. That service users preferred daily routines including rising and bed times, meal and leisure preferences are recorded and staff adhere to them as required. 16 (2) (i) That alternative meals are offered for each meal at that all meals are served hot. 13(3) That all staff be trained in adult (6)(7)(8) protection. 23(1)(d) That high standards of 16(2)(j) cleanliness are maintained (k) throughout the home, including the elimination of offensive odours. 26 (1) (4) That the Registered Provider (a-c) (5) makes monthly visits to the (a) (b) home and makes the subsequent reports available for inspection. 16(2)(j) That all staff are trained in infection control and follow it in practice. 12(1)(a) An induction training programme (b)(c) must be carried out for all new 18(1)(a) staff that is in line with the (c) Common Induction Standards. (Timescale of 30/11/06 not met). 18 (1) (c) That all staff are trained in (i) dementia care. 8 (1) That a suitably qualified and experienced person be recruited to manager the home. 13(5) That all staff have up to date training in manual handling and follow it in practice. 23 (4) That the requirements in the fire (a)(b)(c) safety risk assessment are met, (i) (v) including the locking of the front (d)(e) door and the practice of wedging open fire doors. 12 (2)(3) 23/09/08 23/09/08 23/09/08 23/09/08 23/09/08 23/09/08 23/09/08 23/09/08 23/09/08 23/09/08 23/09/08 The Shires DS0000067518.V365551.R01.S.doc Version 5.2 Page 26 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 1. Refer to Standard OP33 OP15 Good Practice Recommendations That the homes routines demonstrate it is run in the best interests of service users. That the cook is aware of all residents’ food likes and dislikes. The Shires DS0000067518.V365551.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Shires DS0000067518.V365551.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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