Inspection on 13/09/07 for The White House Care Home

This inspection was carried out on 13th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 White House Care Home 05/01/09

The White House Care Home 04/03/08

The White House Care Home 11/09/06

The White House Care Home 12/12/05

The White House Care Home 28/06/05

The White House Care Home 14/12/04

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE The White House Care Home Rivelin Dams Manchester Road Sheffield South Yorkshire S6 6GH Lead Inspector Caroline Long Key Unannounced Inspection 13th September 2007 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000061514.V337807.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. DS0000061514.V337807.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The White House Care Home Address Rivelin Dams Manchester Road Sheffield South Yorkshire S6 6GH 0114 230 1780 0114 230 6638 none None Mrs Julia Pauline Cobb Mr Simon Cobb Ms Julie Dawn Frith Care Home 32 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) Category(ies) of Dementia - over 65 years of age (16), Old age, registration, with number not falling within any other category (16) of places DS0000061514.V337807.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The service users in the category DE(E) will be housed in one building and those in the category of OP in the other. Staffing levels must comply with, at least, those in the publication `Residential Form Care Staffing in Care Homes for Older People` published April 2002. 11th September 2006 Date of last inspection Brief Description of the Service: The White House is a converted property providing personal care and accommodation for thirty-two older people, some who have dementia. The accommodation is on two floors with lift access, and the majority of rooms are single. All areas of the home are accessible to wheelchairs. There is a parking area to the rear of the home The homes registered providers are Mrs Julia Pauline Cobb and Mr Simon Cobb. The home has beautiful views overlooking Rivelin Dams. There are large landscaped gardens and views of the Dams can be seen from the majority of the rooms. The home is located some distance away from shops and other amenities. The weekly fees range from £350 to £405. This does not include costs for items such as hairdressing or chiropody. The registered manager supplied this information to the Commission For Social Care Inspection on the 13th September 2007. Inspection reports are available by requesting them from the home. DS0000061514.V337807.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is what was used to write this report. • • • • Information about the home kept by the Commission for Social Care Inspection. Information asked for before the inspection, this is called an Annual Quality Assurance Assessment. Information from surveys that were sent to people who live at the home, their relatives, health professionals and the staff. An unannounced visit to the home. This was carried out by one inspector and lasted over seven hours and included talking to staff and the registered manager about their work and the training they have completed. And checking some of the records, policies and procedures the home has to keep. Some time was spent observing staff supporting people and talking with the people who live at The White House. Four peoples records were looked at in detail. • • What the service does well: What has improved since the last inspection? DS0000061514.V337807.R01.S.doc Version 5.2 Page 6 People who live at the home and their representatives attend a review of their care annually, this helps to make sure people are receiving the care in the way they want. Improvements have been made to the way in which they record and store medication, this helps to make sure people are receiving the correct medicines A clock and notice board have been put in the dementia unit so people can be aware of the date and time. People are now provided with the correct utensils to enable them to continue eating with dignity. What they could do better: When a person’s health declines or changes the care plans need to accurately reflect this and the actions the staff need to take to meet these changing needs. This is to make sure they receive the specialist advice and care necessary. Robust systems need to be in place to make sure all medication is administered safely to people in the home. Sufficient resources need to be made available to offer a programme of activities, to help people to maintain their life skills. Staff need to be provided with training to enable them to recognise, understand and deal with verbal and physical aggression. This will enable staff to recognise when they are unable to continue to meet a persons needs. The home has offensive odours in the communal areas that are unpleasant for people living in the home, the manager needs to establish the cause of this problem and take the necessary actions to stop the odours. The management must make sure there are always enough staff to make sure people are safe and their full care needs are provided for. The registered manager must follow and record the any complaints received as described in the homes complaints procedure. This is to make sure people feel confident in raising any issues they may have about the care provided. The registered manager must make sure all the appropriate checks and meaningful references are sought, in order to make every effort to ensure that only suitable people are employed. To enable the Commission to monitor how the home deals with any incidents which may adversely affect the well-being or safety of people living at the home the registered manager must inform the Commission when these occur. DS0000061514.V337807.R01.S.doc Version 5.2 Page 7 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. DS0000061514.V337807.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000061514.V337807.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3. People who use the service experience good quality outcomes in this area. People are assessed before moving into the home to make sure it is the right place for them to live. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The registered manager explained if a new person moved into the home she would normally receive a referral from a care manager, following receiving this she would gather together any other information, which was available. She would then visit the person at their home or whilst they were in hospital to carry out an assessment of the person’s individual needs. She would record this on the initial assessment form and then use this information to help plan for their care. DS0000061514.V337807.R01.S.doc Version 5.2 Page 10 All the initial assessment forms looked at as part of case tracking were completed with the necessary details to enable the registered manager to make a decision about whether the persons needs could be met. They also contained specific details about people’s preferences and personal histories. The registered manager explained she would normally give a person a month to settle in and decide whether the home was right place for them. Also, for the home to be sure it could meet the person’s needs. There has only been one new admission to the home since the last inspection. This person was admitted from a hospital some distance away and so the registered manager was unable to visit them. Instead, she telephoned the hospital and asked for information about the person. During the site visit, the records showed this person was not settling into the home, and the staff were having difficulty in meeting their needs due to their illness. However, no action had been taken to review whether The White House was the right place for them to live and if the person needed to be moved to a more suitable care setting. Should the home find they are having difficulties in meeting a persons needs or the person is not settling in well they should ask for a reassessment of this person by a health professional. The staff said and the records confirmed staff have carried out dementia care awareness training. However, due to the high number of incidents where people are displaying challenging behaviour, the staff should now be offered training to enable them to manage these situations. Over half of the surveys returned by people who live in the home said they did receive enough information about this home before they moved in. Comments made were: ‘I found out for myself and found it a very good place, I have been happy here.’ ‘My family came to see.’ The home does not provide intermediate care. DS0000061514.V337807.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 7, 8, 9 and 10. People who use this service experience adequate quality outcomes in this area. People are treated with respect and dignity by the staff, however they cannot be confident their individual health and personal care needs will be met. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: People in the home said they received the care they need and the staff treated them with warmth, dignity and respect. This was confirmed by observing staff during the site visit. There was a well established staff team who were dedicated to meeting the needs of the people in the home, and in the dementia unit during the site visit they consistently reacted skilfully when presented with challenging behaviours. DS0000061514.V337807.R01.S.doc Version 5.2 Page 12 Four peoples’ case records were looked at in order to check that a plan had been formulated which helped staff provide support to people according to their needs and wishes. All the records followed the kardex system; this contained a detailed assessment of the person’s physical and mental needs. From the assessments plans of care were written for washing and dressing, eating and drinking, incontinence and constipation and spiritual and social and sleep patterns, which did contain some personal preferences. These were supported by both a yearly risk assessment for falls and assessment of risks for security and behaviour. However the risk assessments and the care plans did not identify people’s specific needs well and the risk assessments were not detailed with the actions staff needed to take to prevent the risks. Examples of these were: • The risk assessment for challenging behaviour only said to give medication (haloperidol), and did not describe the actions a staff member needed to take to keep themselves and the person safe. In the dementia unit although people were displaying challenging behaviour, there were no care plans about the actions the staff needed to take when this occurred or how to prevent this behaviour from escalating. A person with a skin problem, which was looked at by the district nurse in May and July when treatment was suggested, was not fully reflected in the care plan. • • The care plan system had notes of when medical interventions had taken place, these showed the district nurse, the GP and the chiropodist had visited people. Also a district nurse gave information about how the home were actively involving other professionals when necessary. However there were examples where this had not happened or instructions had not been followed through and these could have been detrimental to people’s wellbeing. For instance: • Where a district nurse had written that a person needed to receive regular fluids the home were not recording the amount of fluids this person was taking. Also where a person was displaying challenging behaviour, their needs had not been reassessed and they had not been referred to the Community Psychiatric Services. • DS0000061514.V337807.R01.S.doc Version 5.2 Page 13 As well as the risk assessments and care plans information was recorded in other separate records. Examples of the different records were: • • • Various tasks were carried out for everyone on a weekly basis and recorded in different charts, such as weighing, bathing and toileting. Daily records were kept, which enabled the staff to track any changes to people’s wellbeing. A communication book that recorded various events, such as incidents and General Practitioners visits, where many of these issues should have been recorded in people’s individual daily records or their care plans. Reviews of the persons care were taking place each year with both the care manager and the relatives to make sure they were receiving the care they needed, however these were not kept together with the other documents. • However it was difficult to follow whether all this information was being collected together in a way, which would have enabled the staff to easily identify if a persons health was changing. The registered manager needs to review the way they make and keep the records to make sure they are easy to follow so that people’s health care can be promoted and maintained. Following a requirement made at the last inspection medication was now being securely stored in the home, and people’s allergies were recorded on their care plans and in front of the medication administration records book. However another requirement made at the previous inspection for the medication administration records to contain General Practitioners or two members of staffs’ signatures alongside any directions regarding the dosage of the medication or the time the medication to be given, had not been carried out on all the record sheets. The medication was only looked at in the dementia unit where the sample looked at was found to be accurate. DS0000061514.V337807.R01.S.doc Version 5.2 Page 14 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. People who use the service experience adequate quality outcomes in this area. People are not always provided with social, cultural and recreational activities that meet their abilities and expectations. Generally, people have a varied diet, according to their choice. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home has an activities organiser who explained she works for two and a half hours a week on a Thursday, when she carries out quizzes, games, crafts and singing took place in the residential unit. In the dementia unit she would generally work with people on a one to one basis and help some of the people attend the activities on the residential unit. The home also organises about two trips a year which people from both units can participate in. Efforts are made to celebrate festive seasons such as Christmas, Valentines Day, and Easter. Also, a monthly interdenominational church service is carried out in the residential unit. DS0000061514.V337807.R01.S.doc Version 5.2 Page 15 People who returned their surveys when asked if there were activities three stated always, two stated usually and two stated sometimes. A comment made on a survey was: ‘Not bad considering there’s not much you can do in a place like this.’ The home has an open visiting policy and a relative commented: ‘Staff makes them feel welcome and have a laugh with them.’ In the residential unit in the afternoon, there was church service and a quiz both which people seemed to enjoy and the activities organiser appeared to be good at including everyone and making sure they had a good time. People said they had a choice about when they got up and went to bed. There was a lot of good-hearted banter with a member of staff. During the site visit approximately two hours was spent in the dementia unit lounge, during this time most people were sat in chairs around the edge of the room whilst music was playing, many were asleep, withdrawn or wandering in the adjacent corridor. When staff were free they would sit with and attempt to initiate conversation, however most their time was spent assisting people with personal care. Although two people went to the hairdresser and two went into the enclosed garden People’s social activities were recorded in their plans of care. For the dementia unit only television or music was recorded for all of the previous week. The home needs to offer people who have dementia activities that will help them maintain their life skills, and suit their individual needs and capabilities. People’s rooms were locked to protect their personal possessions, but it was not clear whether those who had difficulty in communicating would have the choice to access their rooms easily during the day. This resulted in nearly everyone being restricted to the lounge and downstairs corridor where there was little stimulation. Following a requirement made at the previous inspection the lounge in the dementia unit had both a clock and a chalkboard stating the date and time. The news board had Led Zep perform one off concert written on, which did not seem to be appropriate for the people living there. The dining room in the residential unit is part of a large conservatory, which looks out onto magnificent views of the countryside. At teatime the tables had table clothes and were pleasantly set. There was a choice of sandwiches. People in the residential unit said the food was very good. The area manager explained that people living at the home have fresh vegetables from the gardens. DS0000061514.V337807.R01.S.doc Version 5.2 Page 16 Lunchtime was observed in the dementia unit dining area, where people were sat in a very cramped space, however tables were set with clothes and table mats people and everyone was given a full choice of utensils to eat with. The menu on the day of the site visit was braised steak or vegetarian option, followed by jelly or home baked Bakewell tart and custard, everyone on the unit had this to eat and appeared to enjoy it. No special diets were seen in the dementia unit. Staff explained they used to enjoy eating lunch with people, as it helped make the meal an occasion and provided people with stimulation, but this practice had stopped as the provider had commenced charging them for the meal. DS0000061514.V337807.R01.S.doc Version 5.2 Page 17 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. People who use this service experience poor quality outcomes in this area. People are not protected from abuse and the home has not been following its complaints procedure. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Five out of seven people surveyed said they knew how to make a complaint. Two people who live in the home and the staff said they would feel comfortable in complaining to the registered manager. The complaints procedure is advertised in the reception area. On the day of the site visit the registered manager and area manager in response to a complaint they had received introduced a new record of complaints in line with the organisations complaints procedure. Previously the home had kept a complaints and compliments book in each unit on the entrance reception table. These records were looked at and they contained complaints, concerns and compliments from people’s relatives and a response to these issues by the registered manager. The issues raised were TV too loud, loss of glasses, and costs of hair dressing, and asking about eyes testing. The registered manager had not considered that these were DS0000061514.V337807.R01.S.doc Version 5.2 Page 18 complaints about the service offered so had not followed the advertised procedure. A complaint has been received by the Commission about the care a person has received this was being responded to by the provider at the time of the inspection. Also, two concerns have been brought to the attention of the Commission about the promotion of people’s health. On the day of the inspection, the manager was attending an adult protection course, so she could cascade the information to members of staff. The records and staff confirmed they had attended a safeguarding adult course. However, there was doubt by the staff about what actions and procedure to follow. The communication book had records of a number of incidents in the dementia unit that had not been reported to the Commission or to safeguarding adults. It appeared to be accepted that aggression between people living on the unit was normal practice. Also there had been no actions taken by the home to review risk assessments or have people reassessed by health professionals following any recurring incidents, this could put people at risk. The home is not following a robust recruitment procedure that would protect people from abuse. DS0000061514.V337807.R01.S.doc Version 5.2 Page 19 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 and 26. People who use this service experience adequate quality outcomes in this area. People live in a safe environment but areas need to be improved upon to make sure people are living in clean and comfortable surroundings. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home is split into two separate units, an area for people with dementia and a residential area for people who need personal care and accommodation. The residential area of the home appeared to be of a good standard, there was a large conservatory and no unpleasant smells and it was reasonably well decorated. Two rooms visited were of a good standard and decorated with personal possessions, which were age appropriate. People who live in the home said they liked their rooms. DS0000061514.V337807.R01.S.doc Version 5.2 Page 20 The dementia unit is on two floors, ground and first floor; the first floor is accessible by a passenger lift. There are fourteen bedrooms; some have an en-suite toilet and washbasin. The bedrooms were decorated with personal possessions that were appropriate to the age of the person living in the room. However, staff explained one of the communal bathrooms is not used due to the depth of the bath and this is now used for storage. There is a lounge and adjoining dining room on the ground floor, which has a small kitchen area and an entrance to an enclosed garden. The dining area of the lounge is quite small and cramped and only just manages to accommodate the number of people who live in this part of the home. The lounge area has all the chairs around the edge, is quite dark and not very appealing or comfortable, people were mainly restricted to this and the ground floor corridor as their rooms were locked to prevent other people entering them. This dementia area was not very clean, and there was a strong smell of urine in the communal areas and in one of the three bedrooms visited, this odour would have proven to be unpleasant for people living there. Also on the ground floor in the communal areas the decoration was of a poor standard, some of the paintwork was damaged etc. There have been reported incidents of scabies in the home, which have been treated and according to the registered manager is no longer present. Records showed staff have received infection control training, during the site visit gloves, and aprons were available in the home, and staff had hand wash gel to prevent the spread of infection. All areas of possible cross infection should be investigated by the home and resolved, such as the practice of people not having their own personal flannel. Any advice given by the infection control nursing service should be followed precisely. DS0000061514.V337807.R01.S.doc Version 5.2 Page 21 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): Standards 27, 28, 29 and 30. People who use this service experience poor quality outcomes in this area. People receive care from a generally trained staff team, however the inadequate number of staff and some aspects of the recruitment process has the potential of placing people at risk. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home has an established staff team; the registered manager explained people who start working there tend to stay. Staff were observed to know the people well and be both kind, respectful and warm to them. The staff explained and the records confirmed that, for each unit there are generally one senior carer and one carer working for each shift. The registered manager generally works a nine to five shift. Generally on the residential unit this was found to be enough but on the dementia unit some staff said this was difficult and this was evidenced during the inspection, where the level of staffing severely restricted the ability of the service to deliver person centred support. During the site visit, the level of the dependency was high on the dementia unit; some people needed at least two members of staff to help them with DS0000061514.V337807.R01.S.doc Version 5.2 Page 22 their personal care and some people were displaying challenging behaviour, which required staff intervention. An example was during the inspection when two members of staff went to the toilet there was no one in the lounge area, a person tried to move from their chair and nearly fell. The dementia unit is on two floors which means when a person upstairs needs help this leaves no one on the ground floor. Half of the staff has achieved their national vocational training at level two in care or above Training records showed people were receiving induction training and mandatory training which was up to date this was confirmed by the staff during the site visit. Mandatory training such as health and safety and food hygiene and mobility assistance was kept up to date. Induction training had been carried out. However there was no evidence of specialist training in managing people with challenging behaviour. The staff records looked at did not protect people in the home. For two staff that had been employed since the last inspection both had commenced work before a protection of vulnerable adults and criminal record bureau check and references had been received. DS0000061514.V337807.R01.S.doc Version 5.2 Page 23 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, 33, 35 and 38. People who use this service experience good quality outcomes in this area. The home is managed in a manner that seeks to improve standards of care in order that people receive a better service. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The registered manager has a registered managers award and her national vocational qualification level four in care. All the staff felt the manager was very approachable and felt well supported by her. During the inspection she explained she was committed to improving the home. The area manager started in May and is providing the registered manager with support, she carries out regular visits to the home where she monitors the service provided. DS0000061514.V337807.R01.S.doc Version 5.2 Page 24 The operational manager is commencing a range of monthly audits, which will provide a quality assurance system for the home. These will cover medication, records and care plans. The registered manager also explained they send out half yearly questionnaires to relatives and people who live in the home to find out their views. These were looked at some were positive and some were negative. One evidenced a relative was concerned about their relative who had a large bruise on their face but liked the way they were treated as an individual. However, the outcomes of this report shows that the quality assurance systems need to be improved upon to make sure the service is operating in the best interest of the people who live there. Staff said there were regular staff meetings and supervision and the records confirmed this. The registered manager explained no money is kept on the premises; people are invoiced directly for any extra costs. The Annual Quality Assurance Assessment form states all the equipment has been maintained; two were sampled and found to be up to date. A fire risk assessment is in place, the registered manager said the fire training was up to date, although the records did not confirm this and showed some people had not received fire training since 2006. DS0000061514.V337807.R01.S.doc Version 5.2 Page 25 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 1 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 2 X X X X X X 2 STAFFING Standard No Score 27 1 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X N/A X X 3 DS0000061514.V337807.R01.S.doc Version 5.2 Page 26 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 OP7 Regulation 12,15 Requirement The care plans must be reviewed and evaluated to ensure they identify the changing health, social and personal care needs of people especially following a GP or District Nurse visit. Previous requirement not met 01/11/06 To make sure the home is always able to meet people’s health care, if there are any changes or as their health declines they should be referred to the appropriate health care professional for reassessment. Timescale for action 01/11/07 2 OP8 12 (1) 01/11/07 3. OP9 13 01/10/07 The Medication Administration Records must contain General Practitioners or two members of staffs’ signatures alongside any directions regarding the dosage of the medication or the time the medication is to be administered, this is to make sure people receive the correct medication. Previous requirement not met 01/10/06 DS0000061514.V337807.R01.S.doc Version 5.2 Page 27 4. OP12 16 All the people who live in the home must be given the opportunity for stimulation through suitable leisure and recreational activities. Previous requirement not met 01/12/06. The registered manager must follow and record the complaints as described in the homes complaints procedure. This is to make sure people feel confident to raise any issues they may have about the care provided. 01/11/07 5 OP16 22 13/09/07 6 OP18 13(6) All staff needs to be provided 01/01/08 with specialist training to enable them to recognise, understand and deal with verbal and physical aggression appropriately. This to enable staff to recognise when they are unable to continue to meet a persons needs. The management must review its staffing numbers to make sure the needs of people in the home are always met. The home must obtain all relevant information and documents before new employees commence work. Previous requirement not met 01/11/06. The registered manager must inform the Commission of any incidents in the home, which adversely affects the well being, or safety of any people who live there. 01/11/07 7 OP27 18 8 OP29 19 01/11/07 9 OP37 OP38 37 01/11/07 DS0000061514.V337807.R01.S.doc Version 5.2 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard OP7 OP15 OP26 OP30 Good Practice Recommendations To protect people from potential harm, risk assessments should contain the actions needed to prevent risk. Staff should be encouraged to eat with the people in the dementia unit this helps people to maintain their social skills. To make sure the home is a pleasant environment for people to live it, the reasons for the smell of urine should be established and the smell removed. To make sure staff are able to keep people safe they should receive the appropriate training on how to manage challenging behaviour. DS0000061514.V337807.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR 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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