Inspection on 29/11/08 for The Shires

This inspection was carried out on 29th November 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 23/06/08

The Shires 04/07/06

Extracts from inspection reports are licensed from CQC, this page was updated on 06/02/2009.

CARE HOMES FOR OLDER PEOPLE The Shires 12 - 13 Gorringe Road Eastbourne East Sussex BN22 8XL Lead Inspector Gwyneth Bryant Unannounced Inspection 29th November 2008 08:30 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 Shires DS0000067518.V373179.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.V373179.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 Manager post vacant Care Home 27 Category(ies) of Dementia - over 65 years of age (27) registration, with number of places The Shires DS0000067518.V373179.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 23rd June 2008 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.V373179.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 in just over six 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 three were spoken with. The appointed Manager and one member of staff 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, daily notes, personnel and medication records 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. Following the site visit the manager informed the CSCI that the information in the AQAA was inaccurate as some parts had not been updated to reflect the current situation in The Shires. The home has recently carried out a survey for families and friends of residents and the outcomes are included in this report. Due to the need to repeat requirements from the last key inspection we are considering taking enforcement action against the home. What the service does well: What has improved since the last inspection? Of the seventeen requirements made at the last inspection only four had been met in full and these were in respect of the Registered Provider making unannounced monthly visits to the home, staff induction, the appointment of a manager and fire safety. The Shires DS0000067518.V373179.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.V373179.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.V373179.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): 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 for the last two people to be admitted were viewed and while they identified most needs, not all parts had been completed and nor did they include information as to how the home will meet needs. For example, one persons assessment showed that they were Roman Catholic and went to the local church each Sunday but there was no information to show how this important spiritual need was to be met by the home. Although a Catholic Priest visits the home regularly discussion with the manager found that she had yet to consider how to enable the individual to actually visit the local Church each Sunday. Following the site visit the manager stated that at the time of the assessment not all information was available. It is important to ensure that needs are The Shires DS0000067518.V373179.R01.S.doc Version 5.2 Page 9 assessed thoroughly prior to admission to ensure the home can demonstrate it can meet needs. On viewing the care plans they were found to be inconsistent with the information in the pre-admission documents so it is not clear if the initial assessment was incorrect or if the information from the assessment record had not been carried forward into the care plan. The Shires DS0000067518.V373179.R01.S.doc Version 5.2 Page 10 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): 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 residents are not at risk. EVIDENCE: Five care plans were viewed, of which two were in the new format devised and implemented by the newly appointed manager. On viewing those care plans in the old format; little had changed with a lack of regular review and direction to staff in meeting needs. These care plans had additional sheets to cover nutritional needs and cognitive needs, however one persons cognitive needs sheet had not been completed and none of the nutritional needs sheets included direction to staff on how to improve nutritional intake. Therefore it is not clear what action needs to be taken to improve this aspect of care or who takes responsibility for monitoring nutrition. The new format is called an Individual Service Plan (ISP) and there was an indication that they were person centred and included aims and objectives. The Shires DS0000067518.V373179.R01.S.doc Version 5.2 Page 11 However, they did not include direction to staff as to how to meet identified needs and this is crucial given that people living in The Shires are vulnerable and often unable to communicate a need. Care plans included a sheet outlining triggers for challenging behaviour but in two instances the information was inconsistent with other parts of the plan and while there were instruction to staff to use distraction techniques there was no information as to what these techniques may be or if staff had the skills and knowledge to apply them. In general care plans did not accurately reflect current care needs as they had not been updated and reviews tended to just be a signature and a date. One care plan had not been updated in its entirety since 2007. For example one persons night routine stated she likes to have the door propped open with a footstool but the Registered Provider has told the CSCI that automatic door closers have been fitted to all doors that require them. Another care plan stated that the individual is self caring so no moving and handling risk assessment had been done but other information showed they needed assistance with bathing. Risk assessments had been carried out for residents at risk of falls, pressure sores and manual handling and included the level of risk. However, they still lacked the direction to staff in reducing the risk. Again the daily notes were variable with some giving good information as to how an individual spent their day and others which just had comments such as had a good night or was fine. The daily notes frequently included reference to incidents between residents and although one Safeguarding Adults alert was made, a full report was not found nor were there detailed plans to show how further incidents were to be reduced. There were notes in the diary to indicate that a relative had to request that a GP be consulted due to a rash on their mothers legs. Staff practice should ensure that it is not left to relatives to point out any conditions that may need medical attention. Following the site visit the manager stated that the home had been monitoring the individual and that the GP had been consulted in the past. Information in care plans did indicate that healthcare needs such as opticians and chiropody are identified and met. It was disappointing to note that there remain a number of shortfalls in the medication procedures. There were some gaps in the medication administration records so it was not always clear whether or not medication had been given. The minutes of the staff meeting indicated that there had been a medication error whereby a nighttime medication had been signed for but not given and the carer had to ring the deputy manager for clarification. This was also recorded in the daily events book but there was no information as to the action to be taken to prevent further errors. The carer doing the medication appeared to be signing all medication sheets at the same time but explained that she was merely checking that she had administered all the medication. She added that only pain relief medication is given with breakfast and other medication given later so the 8.00 medication was given after 11am and when questioned the carer said that lunchtime The Shires DS0000067518.V373179.R01.S.doc Version 5.2 Page 12 medication would still be given at the usual time of 12.30 and explained that this has always been the practice in the home. It is important to ensure medication is administered in line with the prescribed times to ensure doses are given at appropriate intervals. Any medication that is refused is stored in an envelope with the name of the person who refused and the name of the medication. However, there were four envelopes containing tablets that had been found on the floor of the lounge which suggests that staff do not observe people taking their medication but sign to say it has been administered. In addition MAR charts showed that these medications had been signed for as administered. Following the site visit the manager informed the CSCI that medication is administered within time guidance issued by the GP and that as there were 26 people in residence on the day it is not possible to administer all medication at 8am. The storage for Controlled Drugs is satisfactory but the manager was unable to find the controlled drugs register on the day so the administration of these drugs could not be recorded in line with good practices. Following the site visit the manager confirmed that the register is held with the MAR charts so all controlled drugs could be recorded in line with good practice. The Shires DS0000067518.V373179.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 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. The lifestyle experience by people living in the home does not match their expectations, choice or preferences. Meals choices have improved but daily routines need to be improved. EVIDENCE: Care plans did include preferred rising times and times of going to bed however there were indications that they were not adhered to. The tour of the premises found that there are still no locks on communal toilets and bathrooms and this needs to be addressed as it impinges on the privacy and dignity of people living in the home. Following the site visit the manager stated that locks had not been fitted in case a resident locks themselves in, however, locks on communal doors need to be of a type that facilitates staff access in such instances. In the staff room there was a list of tasks for staff and it was such that it was evident that the home continues to be run to suit staff routines rather than in the best interests of residents. Following the site visit the manager confirmed that although there is a list of tasks to be completed staff are not required to complete them at a specified time. The Shires DS0000067518.V373179.R01.S.doc Version 5.2 Page 14 Three people were in the dining room at the start of the site visit and were still there after 11am and they had not been bathed or dressed and there were indications that at least one needed to be taken to the toilet. The daily notes indicated that one person has asked to be given a flask so they could have a cup of tea when they wanted one but there was no information to show this had been provided. It is important to ensure reasonable requests are granted and all staff take responsibility for ensuring individual preferences are followed each day. Following the site visit the manager confirmed that the individual had been provided with a flask as requested. A daily programme of activities has been devised however the week prior to the visit showed that an activity was provided on just one day due to staff shortages. While it is accepted that at times staff shortages do occur it is not acceptable for residents leisure and social needs to remain unmet as a result. At the start of the site visit all residents were up and given breakfast at 8.30am although the deputy manager did say they had all been given a hot drink on rising. Daily notes indicated that although some residents chose not to go to bed, staff were persuading them to go. It is crucial to respect the autonomy of residents and ensure their individual routines are respected. On the day no one was offered a choice of breakfast and once again a tray of toast was brought from the kitchen to the dining room. It was covered with greaseproof paper so would not be hot when eaten by residents. The morning routine was discussed with the manager who agreed that residents should be given breakfast when they choose rather than to suit staff routines. Following the last site visit the Registered Providers action plan indicated that residents would be enabled to get up and have breakfast at a time of their choosing but this has not happened in practice. The manager agreed that there is still work to be completed in the morning to ensure the best service delivery to residents in particular breakfast time and she is working on this issue. The visiting policy remains the same with an open house policy ensuring visitors are welcome at all times. Comments from the surveys indicated that relatives and friends of residents were made to feel welcome and offered refreshments. As at the previous site visit it was good to note that a range of fruit is offered as part of the breakfast menu. A new menu has been devised and is due to be implemented which indicates that meals will be well balanced and nutritious and alternatives offered for each meal. One person spoken with said how much they enjoyed the food and commented that there is always plenty of it. One other person said the meals were okay, as they did not like the fancy stuff, as they preferred plain English food. The Shires DS0000067518.V373179.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): 16 and 18 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 recording of complaints and to ensure all staff are familiar with current adult protection systems EVIDENCE: Information in the AQAA indicated that there are policies and procedures on both the handling of complaints and Safeguarding Adults. The AQAA showed that there have been five complaints since the last inspection and three Safeguarding Adults alerts but there were no records of the complaints in the complaints log. In addition there was only one record available in respect of the Safeguarding Adult alerts. Following the site visit the manager confirmed that the details in the AQAA were inaccurate in that the home had not received any complaints since the last inspection nor had there been any safeguarding adult alerts. The AQAA also indicated that there was an incident whereby a carer was unaware of what constituted abuse; again there was no record of this available on the day of the site visit. It is important to record all complaints and Safeguarding Adults incidents both as part of the quality monitoring process but also to reduce such incidents. The manager said that some staff have been trained in Safeguarding Adults and there is a plan to extend this to all staff to ensure they are aware of what constitutes abuse and how to make an alert. The Shires DS0000067518.V373179.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): 19 and 26 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 well maintained and décor is generally good, with individual bedrooms being attractively decorated and comfortable. However, due to known problems with the plumbing three rooms were very cold and water delivery temperatures were variable. In addition none of the radiators in the communal areas were working. This was discussed with the manager who explained that a plumber was due to visit the following week and she intended to use fan heaters until the heating was fixed. However, it is important to ensure heating systems are regularly serviced and repaired more promptly to ensure residents are not cold. Following the site visit the manager said that the heating had been turned off on the day by a The Shires DS0000067518.V373179.R01.S.doc Version 5.2 Page 17 resident and the faults with the other radiators have now been fixed. Action needs to be taken to ensure residents do not have access to heating controls. Two rooms were found to be malodorous and as one was a shared room, this needs to be addressed to ensure bedrooms are comfortable for both residents and visitors. One bathroom and one shower room did not have gloves and aprons available for staff use and this needs to be rectified to ensure staff have easy access to protective clothing. One carer was seen to be wearing gloves and an apron in a communal area after giving personal care. Another carer wore the same apron whilst taking different individuals to the toilet. In order to minimise cross infection it is important for staff to follow good practice and use fresh gloves and aprons for each individual and to ensure they are disposed of in lidded bins. Laundry facilities remain good with machines that wash at temperatures that reduce the risk of cross infection. It was of concern that in the laundry there was a notice requesting that the vent not be blocked but on the day it was blocked with a pile of clothes. This needs to be monitored to ensure it is not regular practice. The Shires DS0000067518.V373179.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): 27, 28, 29 and 30 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 insufficient staff to meet the needs of people living in the home and improvements need to be made to all aspects of staff training and to the recruitment practice. EVIDENCE: On the day of the site visit there were just three care staff on duty and the manager said there should be four. However the improvement plan from the Registered Provider stated that there were five care staff on duty at each shift. As residents were left unsupervised on more than one occasion it is evident that current staffing levels are inadequate and therefore care needs cannot be met. The manager confirmed that there are two night waking staff on duty and cooks, general assistants and housekeepers are also employed. A cleaner is employed each day so staff do not undertake domestic duties in addition to care duties. Following the site visit the manager indicated that there are insufficient staff to enable all medication to be administered to 26 residents at 8am. Therefore additional staff need to be deployed to ensure care needs can be met in full. The manager said she has begun to provide staff with formal supervision and is using the sessions to identify training needs. The Shires DS0000067518.V373179.R01.S.doc Version 5.2 Page 19 The AQAA indicated that 75 of care staff had achieved National Vocational Qualification level 2 in care but on the day the manager said that due to staff resigning the current level was 50-60 . This shows that the home currently meets the required number of care staff with this qualification. Recruitment records for the last three people employed were viewed and each had provided the required documentation prior to starting work except one person who did not have a reference from their last employer. Not all staff had provided a full employment history with a written explanation for any gaps and this needs to be addressed. Following the site visit the manager confirmed that the individual had not provided a reference as they had been unemployed for six years prior to working at The Shires. Induction files were not available and the manager explained that she asks staff take them home to enable them to read them thoroughly. There is also a checklist for all new staff which covers a six month period to ensure new staff are familiar with the homes policies and procedures. The manager is aware that there remain a number of shortfalls in respect of staff training with a need to ensure all staff are trained in manual handling, infection control, fire safety, , first aid and Safeguarding Adults. These need to be addressed to ensure staff have the skills to deliver consistent care safely. The Shires DS0000067518.V373179.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): 31, 33, 35, 37 and 38 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. Improvements still need to be made to all aspects of management and systems need to be put in place to ensure all aspects of service users health, welfare and safety are protected and promoted. EVIDENCE: Discussion with the appointed manager found that she is educated to degree level and has achieved the Registered Managers Award. In addition she is a manual handling trainer and has experience in dementia carer and sheltered housing. She needs to achieve at least National Vocational Qualification at level 4 in Care to fully comply with regulations. In the past the frequent manager changes have led to a lack of direction and leadership for staff which leads to a poor outcomes for management overall and the current manager has not been in post long enough to achieve significant improvements across all aspects of the service. The Shires DS0000067518.V373179.R01.S.doc Version 5.2 Page 21 As part of the quality monitoring service the Registered Provider makes monthly unannounced visits to the service and the subsequent reports made available to the CSCI. It was disappointing to note that the report sent to CSCI for November still showed Wyndam House at the top of the report. In addition this report and the ones for the previous three months indicated that there were not complaints or concerns but information in the AQAA and daily notes showed that there had been both complaints and Safeguarding Adult alerts, in addition to the medication error. It is important that these visits are thorough and accurately reflect what has happened in the home during the month to enable the Registered Provider to take action to address any shortfalls. Following the site visit the manager confirmed that the medication error occurred after the monthly visit and as mentioned earlier in this report the AQAA was inaccurate. The home does not handle the finances of anyone in the home; any items provided are receipted and added to the monthly invoice. The manager said that she has begun to have staff meetings and a newsletter has been produced to inform staff and relatives of events in the home or any changes. This was viewed and found to be very informative on what is happening in the home. The home has recently carried out a survey for families with 14 returned so far. These were viewed and it was good to note that a number of people took the time to add various comments. Generally responses were varied with some people very satisfied and others not very satisfied. Meals, daily routines and lack of activities were all areas that were not as good as they might be. Although most praised the staff with comments indicating that they are kind and caring towards residents and welcoming to visitors. As part of the quality monitoring process internal audits are carried out including for medication. Given the errors in the medication charts and practices it is clear that the competence of the auditor needs to be ascertained. Following the site visit the manager pointed out that the medication audits had only been implemented in the two weeks prior to the inspection and there was an expectation that they would be more robust in the future. It was of concern to note that one resident was transported in a wheelchair that did not have a footplate. Another carer was seen to seat a resident in a chair and then swivel it and push it under the table. While the design of the chair is to facilitate easy movement, they are not designed to be used in such a way as it puts both the carer and resident at risk of injury. One person being led to the table did not have their slippers on properly and the carer did not notice so the inspector had to point it out. It is important to ensure footwear is properly fitted to reduce the risk of falls. The manager has carried out a fire safety risk assessment and has requested that someone from the fire service visits to review the assessment and check fire safety. There was evidence to show that fire alarms, emergency lighting and water delivery temperatures are tested weekly and action taken to address shortfalls. The Shires DS0000067518.V373179.R01.S.doc Version 5.2 Page 22 However, water temperatures were variable on the day and the manager explained that it was due to problems with the plumbing. While there are arrangements to monitor falls, the records do not clearly indicate what action will be taken to reduce falls, although the manager said she intends to do so in the future. The home needs to develop a system to notify the CSCI of any incidents relating to medication errors, Safeguarding Adult alerts or any other incident that affects the wellbeing of residents. The Shires DS0000067518.V373179.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 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 1 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 X 2 2 The Shires DS0000067518.V373179.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 completed and include information as to how the home will meet assessed needs and be signed and dated. (timescale of 23/09/08 not met in full). That all service users have a completed care plan and that all plans are regularly reviewed to accurately reflect current care needs. (timescale of 23/09/08 not met in full). Risk assessments undertaken for those at risk of falls and tissue breakdown must include the management of the risk and be regularly reviewed. (timescale of 23/09/08 not met in full). All staff who administer medication must follow good practice and that all medication administration records are clear accurate and up to date and that staff adhere to the prescribed dose times. That the home is conducted to DS0000067518.V373179.R01.S.doc Timescale for action 29/01/09 2 OP7 15 (1) (2)(b)(c) 29/01/09 3 OP7 13 (4) (b) (c) 29/01/09 4 OP9 13(2) 29/01/09 5 OP10 12 (4) (a) 29/01/09 Page 25 The Shires Version 5.2 6. OP12 16 (2)(m)(n) 12 (4) (a) 12 (2)(3) 7 8 OP14 OP14 9 OP16 21 (1) (2) (3) (4) (8) 17 (1) 10 OP18 111. OP18 13(3)(6) (7)(8) 23 (p) 12 OP19 13 OP26 16(2)(j) 14 15 OP28 OP29 18 (1) (a) 19 (1) (b) (c) ensure the dignity of service users is protected and promoted at all times. (timescale of 23/09/08 not met in full). That the planned programme of activities based on service users interests be carried out in practice. That locks be fitted to all doors in communal bathrooms and toilets. That service users preferred daily routines including rising and bed times, meal and leisure preferences are recorded and staff adhere to them as required. (timescale of 23/09/08 not met in full). That all complaints are recorded and include actions taken and outcomes and be available for inspection. That detailed records of any Safeguarding Adult alerts be maintained and be available for inspection. That all staff be trained in Safeguarding Adult procedures. (timescale of 23/09/08 not met in full). That a system is in place to ensure the heating and hot water systems are properly maintained and in good working order. That all staff are trained in infection control and follow it in practice. (timescale of 23/09/08 not met in full). That a review of staffing levels be carried out based on service users dependency levels. That all staff provide a written reference from their last employer and a full employment history with an explanation for any gaps. DS0000067518.V373179.R01.S.doc 29/01/09 28/02/09 29/01/09 29/01/09 29/01/09 29/01/09 29/01/09 29/01/09 29/01/09 29/01/09 The Shires Version 5.2 Page 26 16 17 OP30 OP37 18 (1) (c) (i) 37 18 OP38 13(5) That all staff are trained in dementia care. (timescale of 23/09/08 not met in full). That arrangements are made to notify the CSCI of any Safeguarding Adult alerts, medication errors or other incidents that affect the wellbeing of service users. That all staff have up to date training in manual handling and follow it in practice. (timescale of 23/09/08 not met in full). 29/01/09 29/01/09 29/01/09 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 OP33 Good Practice Recommendations That the homes routines demonstrate it is run in the best interests of service users. The Shires DS0000067518.V373179.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.V373179.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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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