Inspection on 24/09/07 for Two Gates House

This inspection was carried out on 24th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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

Two Gates House 26/06/09

Two Gates House 17/04/08

Two Gates House 28/01/08

Two Gates House 01/02/07

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Two Gates House 42-44 Two Gates House Two Gates Lane Colley Gate Halesowen B63 2LJ Lead Inspector Mrs Cathy Moore Key Unannounced Inspection 24th September 2007 07:10 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 Two Gates House DS0000066258.V346183.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. Two Gates House DS0000066258.V346183.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Two Gates House Address 42-44 Two Gates House Two Gates Lane Colley Gate Halesowen B63 2LJ 01384 567448 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) Wellmun Care Limited Ms Lynda Jane Smith Care Home 17 Category(ies) of Old age, not falling within any other category registration, with number (17) of places Two Gates House DS0000066258.V346183.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st February 2007 Brief Description of the Service: Two Gates is a large, detached property, located in a residential area of Colley Gate, Halesowen, providing personal care for seventeen residents. The home does not provide nursing care. Accommodation comprises fifteen single rooms, twelve of which have en-suite facilities and one double bedroom, toilets and bathrooms situated on two floors accessible via a passenger lift. The lounge, dining area, kitchen, laundry, and office are situated on the ground floor. The home has ample car parking space at the front and to the rear a patio area, accessible via the patio doors leading off the lounge area and offering a number of chairs and tables where the service users can sit in the spring and summer months. The main garden area is grassed with flowerbeds and a number of shrubs. The fees for this service are £347 -£400 per week. Other services examples being; hairdressing and private chiropody are charged for additional to the weekly fee. Two Gates House DS0000066258.V346183.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector carried out this unannounced inspection, on one day between 07.10 and 16.50 hours. Before the inspection we sent a questionnaire to the manager to complete to give us up to date information about the running of the home. This questionnaire was not very well completed. It did not give us much information about what the manager feels the home does well, what has improved or tell us about long- term development plans for the home. During the inspection we looked at three residents files paying attention to assessment processes, care plans and risk assessments. We spoke to these three residents to find out what they think about the service provided. We spoke to five staff. The manager was involved throughout the day with the inspection. We did not speak to any relatives. The only ones on site had come to the home as a resident was very poorly. We did not think it was sensitive to ask them questions at that time. We looked at parts of the premises, which included; three bedrooms, 3 toilets, the bathroom, shower room, laundry, kitchen, the lounge, dining room and the garden. We looked at medications and medication safety. We looked at three staff files to see how well recruitment and training is managed. What the service does well: All three residents spoken to were complimentary about the home. One told us; “I am content and happy”. Another described the home as being; “ Excellent.” The third told us; “ I think the place is great. If I were in Buckingham Palace I would not be looked after better. I am happy”. We observed lots of chat between residents’. We saw plenty of smiles and heard laughing. One resident said to us jokingly; “ Next time you inspect here make sure you bring the chocolates”. Two Gates House DS0000066258.V346183.R01.S.doc Version 5.2 Page 6 The home has a good size car park to the front, which is in a good state of repair. The lounge and dining areas are pleasant, comfortable and warm. The home is located in a pleasant residential area close by to a range of shops, public houses and other public facilities. Main bus routes are situated not far from the home allowing access to surrounding towns such as Halesowen, Stourbridge and Cradley Heath. Residents’ have access to a wide range of professional health care services. The home has a mechanical sluice machine, which increases infection control within. The atmosphere of the home was warm and welcoming. The home has an open visiting policy. Residents are very much encouraged to maintain contact with family and friends. Well over 50 of the care staff team have achieved NVQ level 2 or above. This means that these staff have been assessed as being competent to undertake their work. What has improved since the last inspection? Redecoration has been undertaken in corridors and the dining room. New carpets have been provided in the lounge and dining room. Externally, the rendered surface has been repaired and repainted. As we have stated previously. A questionnaire was sent to the manager for completion prior to the inspection, which was completed to a poor standard. The manager apart for raising the issue about needing to improve care plans, missed the opportunity to tell us where the home has improved in the last twelve months and what improvements are being planned for the next twelve months. Two Gates House DS0000066258.V346183.R01.S.doc Version 5.2 Page 7 What they could do better: Within the last eighteen months the home has had a new owner. The previous owner was on site during business hours every week. The new owner only visits the home once a week. The manager and staff told us that at times they find this new culture difficult. The manager told us that before the previous owner did a lot of things for instance; it would have been her who filled in the Commissions Annual Quality Assurance Assessment, which had on this occasion been completed to a poor standard. The owner and manager need to discuss these new management arrangements for the home and confirm who is responsible for what. The manager has learning and support needs, which need to be addressed. We were told that there are on going problems with the ordering of shopping, particularly food. Items that have been ordered by the home via the owners are not always delivered as per order. We were concerned that there was no fresh fruit available in the home at all on the day of the inspection and were told only minimal fruit is ordered once a week. We found that care planning systems were not adequate in terms of format and content. For example; there was no care plan in place to give instruction for staff on how to deal with one resident’s confusion and short- term memory needs. Risk assessments regarding nutrition and tissue viability are either not being carried out or are not being carried out frequently. Residents are not being weighed regularly as should be happening. The home has not got a set of sit on scales to weigh residents’ who are unable to stand on their own. We found a number of shortfalls concerning medications. For example; there were no instructions for one residents’ Allendronic Acid, which has to be given to a particular way. We did four audits of different tablets, two revealed the wrong number of tablets were left. There were no risk assessments in place for residents’ who self administer their prescribed medication. These shortfalls could place residents’ at risk. Following an allegation of financial abuse a staff member had been dismissed. This allegation had not been reported to the Commission or Social Services as it should have been. Further, there was no evidence to confirm that the staff member had been referred to the Protection Of Vulnerable Adults ( POVA) list as should have happened. We found staffing levels to be inadequate. Only two carers are provided at any time. These carers, in addition to caring tasks have to undertake laundry and during breakfast and tea times- catering duties. On the day of the inspection fifteen residents’ were accommodated one of whom, was very poorly and Two Gates House DS0000066258.V346183.R01.S.doc Version 5.2 Page 8 unfortunately passed away before the inspection finished. yet there were only two care staff on duty. We did not find any evidence to confirm that a ‘ dedicated ’ senior is provided when the manager is not at the home. There was no evidence to confirm that carers in charge of shifts have been assessed as being competent to undertake this responsibility or indeed are willing to take on the responsibility of ‘ senior’. We saw that the majority of radiators throughout the home including those in bedrooms, toilets and bathrooms are not guarded, as they should be to prevent risk of burns to residents. We identified that many radiators in toilets, bathrooms and hallways were not turned on. We saw that one radiator in the ground floor hallway has been removed. We saw that bedroom doors 16 and 17 did not close properly into their rebates, which could pose as a fire risk. Although a requirement was made in the previous inspection report dated 1 February 2007 for the owners to produce a monthly written report of their findings from visits to the home this is still not being met. 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. Two Gates House DS0000066258.V346183.R01.S.doc Version 5.2 Page 9 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 Two Gates House DS0000066258.V346183.R01.S.doc Version 5.2 Page 10 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): 1,3. Quality in this outcome area is Good It is positive that an assessment of all new residents’ is undertaken before they are admitted. Further development is needed in terms of information about the home being available for new and existing residents’. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager showed us the home’s statement of purpose and service user guide that she is in the process of updating. We asked for a copy of these documents and was told that these were the only ones. We did not see a copy of the statement of purpose or service user guide on display in the homemeaning that these documents are not widely available for new or existing residents’ or their families’ to read. Two Gates House DS0000066258.V346183.R01.S.doc Version 5.2 Page 11 We saw written evidence to demonstrate that new residents’ are assessed before they are offered a placement. The manager told us that new residents ‘ where possible are encouraged to visit the home before they move in. She further told us that due to conditions and illness mostly it is the families that make a pre-admission visit to the home. One resident did tell us; “ I came and looked around the home before I came in”. Another resident told us; “ I was in hospital so could not come. My niece came and had a look. She took photos of the bedroom and lounge for me to look at so I could make a choice”. She also told us; “The manager came to see me whilst I was in hospital”. From observation during the day and records we viewed it was clear to us that the home does only admit residents’ who fall within their category of registration, which is older people. This indicates that effective preassessment processes are in place. Observations during the day showed us that the majority of residents’ have no cognitive impairment and are able to mobilise either with an aid or independently. One resident we spoke to did have a degree of confusion and a poor short term memory. However, records we saw told us that she had lived at the home since 2001 so it is probable that the confusion and poor short term memory have worsened since this time. Two Gates House DS0000066258.V346183.R01.S.doc Version 5.2 Page 12 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): 7,8,9,10,11. Quality in this outcome area is adequate. Comprehensive care plans need to be produced to give staff clear guidance and instruction on how to meet individual needs. Improvement is needed in terms of risk assessment and on-going assessments, which should be used to prevent deterioration. Medication systems and management need improvement in a number of areas, as shortfalls identified present as a risk to residents’. Residents are treated with respect. Generally information is available to confirm the last wishes of each resident. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager did highlight in the homes Annual Quality Assurance Assessment that there were shortfalls with care plans. She wrote; “ I would like to up date the care plan to give more information on the service user.” Two Gates House DS0000066258.V346183.R01.S.doc Version 5.2 Page 13 We looked at the files of three residents. We did not see a care plan format that was fit for purpose for example there was no document available to confirm needs and risks then instruction on how to manage these. We did see however that a ‘ monthly review’ tool is used which details care and events. We saw that this form is informative and were pleased to see that where possible relatives are asked to contribute to this process and sign to show agreement. We did note that there was a lack of information and guidance for staff regarding one residents confusion and poor short term memory. We saw that hospital information and diagnosis of Rheumatoid Arthritis for one resident DH had not been recorded therefore there was no instruction for staff on how to managed this. We also noted that there had been no monthly review done for RG since 15.3.07. Evidence we gained overall showed us that proper care plans do need to be produced which must include all needs and risks. We looked at health care provided to the three residents we focussed on during the inspection. For one HH we saw records to indicate that she had been seen by the following health care professionals; 16.2.07 Nurse. 24.2.07 Ambulance – hospital. 12.3.07 Nurse. 16.3.07 Dentist. 22.3.07 Dentist. 8.5.07 Physiotherapist. 15.5.07 Physiotherapist. 6.6.07 Chiropodist. For RG We heard him discussing a pending Chiropodist appointment with the manager. We saw records to indicate that he had been seen by the nurse a number of times between the following dates; 26.6.07 and 18.9.07. We saw records to indicate that an additional resident EM had received the following services; 6.3.07 nurse. 8.3.07 Occupational Therapist. 16.3.07 Dentist and 9.7.07 Chiropodist. One resident DH told us; “ I have seen the doctor twice since I have been in here. The nurse comes every Monday, Wednesday and Friday and on Tuesday’s I go to the hospital for Physiotherapy. This evidence shows that residents’ do have access to a range of health care services. We observed residents’ regarding their appearance and saw that HH wore glasses that were clean. Her hair was tidy, teeth, tongue and nails were clean. Her clothes were smart and co-ordinated. We also saw that DH was well dressed. Her hair tidy and nails clean. These observations indicate adequate levels of personal care within the home. We did note that there are shortfalls with monitoring and prevention of deterioration in health. We noted that there was a lack of records regarding the monitoring of each residents’ weight. For example; There were no records to confirm that DH had been weighed on admission and there were no records to confirm that HH is being weighed. When asked the manager told us; “ We have not got any sit on scales so they can not be weighed”. We asked the manager how many residents’ use aids to mobilise as we were concerned that residents’ who use aids to mobilise were being asked to stand on ‘ domestic Two Gates House DS0000066258.V346183.R01.S.doc Version 5.2 Page 14 scales’ to be weighed and that this may not be safe. We were given four residents names which included; FC, DJ, FT and MG. We told the manager about the importance of regular monitoring of residents’ weights and that a set of sit on scales should be purchased to assist with this process and increase safety whilst doing so. Similarly, we saw that records for assessment of risk in areas such as tissue viability and nutrition were not being undertaken regularly which could mean that first signs of deterioration will not be identified in order to take preventative or corrective action. We identified this shortfall when looking at HH records, we identified that a ‘ Waterlow’ assessment ( which measures tissue risk ) had not been undertaken since 3.5.07. The score at that time was incorrect as no score had been given for age as it should have been. Since May 07 HH has become less mobile which would give a score of 10, which according to the score system would mean that she was now at risk. For RG no Waterlow assessment has been done since 27.4.05. At this time the score was completed as him having healthy skin yet now we saw records as above to confirm that he is receiving regular dressing input from the nurse, which clearly shows that his risk rating has increased but no assessment has been carried out. Similarly, the last time a nutritional assessment was done for RG was 24.4.05. DH was admitted to the home after having a below knee amputation we were very disappointed that there was no evidence to confirm that a tissue viability assessment had been undertaken for her on admission or since. We looked at medication management and safety and were concerned to find a number of shortfalls as follows; One resident JW is being prescribed long term Trimethriprim. Instruction for this medication is that plenty of water or fluids must be drunk yet there was no medication care plan highlighting this instruction. It was stated on the medication records of Residents’ SC and MS that concerning their Aqueous Cream, Emulsifying ointment and white soft paraffin ‘ Done by resident’. We did not see any risk assessment on file to confirm that they were able and safe to do this safely. We asked the manager if risk assessments had been carried out and was told; “ I don’t know”. She was unable to provide us with evidence of risk assessment. We saw that the medication record for residents’ EM, DJ and FT had been handwritten yet there were no staff initials to confirm that the information written had been confirmed as correct by two staff to prevent error. We saw that one resident was being prescribed Allendronic Acid. Administration instructions for this medication are that it must be given 30 minutes before food or other medication and that the person should not lie down for 30 minutes after taking. Although the instructions were on the medication box they were not on the medication record and the medication record did not show that this medication should be given 30 minutes before other medication. We raised this with the manager who was not aware of the instructions. It is probable from this evidence that this medication is not being administered correctly and presents a risk to the resident. Two Gates House DS0000066258.V346183.R01.S.doc Version 5.2 Page 15 We saw that Senna prescribed for MS stated ‘ take one or two’ yet a ring had been drawn around the 2 . There was not a 1 by any staff initial, indicating that 2 tablets were always given not a choice or assessment based on need. Similarly, tablets Co-Codamol for HH were being prescribed as ‘ take one or two’. We did not see that staff are recording how many tablets ‘ one or two’ are been given each time although at the end of each ‘ time’ column a 2 was detailed which indicates that two are being given again not giving choice or under taking an assessment of how many are needed. The manager told us that the doctor had told her that two must be given. We told her that if this is the case the doctor should amend the prescription and the chemist amend the medication record accordingly. We saw that homely remedies Cod liver Oil was written on FT medication record and Ginkgo Biloba for DJ yet there was no evidence to confirm that the doctor had sanctioned these homely remedies. We asked the manager and she told us; “ The doctor has agreed but has not put this in writing”. We carried out audits of different residents tablets to find out if there was the correct number of tablets left against records. We noted that no date had been written on the following medication packets when first used to ensure effective audits examples being; Morphine Sulphate Tablet ( MST) for DH, DH Lansoprazole and MG Omeprazole. We found that OH Zopiclone was correct as there were 12 tablets as there should have been. HH Anastrozole 11 was correct against records and the MST for DH was correct. However there was one tablet short concerning DH’s Lansoprazole and two tablets more than there should have been concerning MG and her Omeprazole. We saw that the medication trolley was chained to the wall in a corridor. The trolley was however, located next to a radiator. We discussed this with the manager advising that a thermometer be put in the trolley and recorded temperatures be taken twice daily. If temperatures go above 25oc, which is the upper temperature limit for the storage of most medications ( with the exception of those needing refrigeration) then a different storage location must be found. We did see some positives regarding medication. Nine staff to date have received medication training. A photograph was available by each medication record to aid correct identification of resident and decrease the risk of giving medication to the wrong resident. There were no staff initial gaps on medication prescribed to be given on a daily basis. We carried out half of the inspection in the lounge area where we could observe the interaction between staff and residents’. We saw that this interaction was positive with residents’ not afraid to approach staff to ask questions or make requests and staff giving good eye contact to residents’ and speaking to them politely. Two Gates House DS0000066258.V346183.R01.S.doc Version 5.2 Page 16 A resident RG told us; “Staff are polite and friendly. They allow me personal space and privacy in my bedroom”. Resident DH told us; “Staff are always friendly. They allow me to do what I can for myself, taking into account my leg. They are always polite”. We saw social services review notes dated 30.6.07 for resident HH which stated; ‘ Lived at Two Gates for 5 years. Family say carers treat with respect at all times”. This evidence shows that the home tries to promote privacy, dignity and respect. Two of the three resident files detailed the residents’ last wishes such as; burial or cremation and name and address of funeral director. This is good practice as it ensures that staff are fully sure of what to do and what information to give to ensure that last wishes are honoured. Two Gates House DS0000066258.V346183.R01.S.doc Version 5.2 Page 17 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): 12,13,14,15. Quality in this outcome area is adequate. Daily routines for each resident are asked about and are honoured. Activity provision is very limited and needs to be improved upon to meet the individual stimulation and leisure needs of each resident. Residents are very much encouraged to and do maintain contact with family and friends. Improvements must be made to ensure that plenty of fruit and vegetables are available at all times. This judgement has been made using available evidence including a visit to this service. EVIDENCE: When we arrived at the home at 07.10 we went into the lounge and saw that only one resident HH was up and dressed. We asked HH if she liked to get up early. She responded as follows; “ I like to get up early I always have”. We looked at records concerning her preferred rising time and saw that they said; ‘ Likes to rise at 06.30 am”. We spoke with two other residents’ about preferred rising times they told us; Two Gates House DS0000066258.V346183.R01.S.doc Version 5.2 Page 18 “ I do need some help but I get up and go to bed when I want to”. “ Get up and go to bed when I want. Sometimes I get myself up at 04.30 hours. I like getting up early”. This evidence is positive and shows that the preferred rising and retiring times of each resident are respected. The manager did indicate in the home‘s Annual Quality Assurance Assessment that there are shortfalls concerning activity provision . This she confirmed further by telling us; “Activities are not carried out very often. The residents’ have asked for more bingo”. We have never had any evidence to suggest concern about visiting or that visiting times are restricted which is positive. Residents’ we spoke to confirmed that they have visitors’. One resident HH told us; “ My son, daughters and granddaughters visit”. Another DH told us ; “ My daughter comes to see me”. With their permission we looked at three residents’ bedrooms HH, RG and DH. All bedrooms held a range of personal effects making them feel homely and personalised. That they can take into the home their own personal effects is a positive indicator that residents are encouraged to take some control over their lives and their personal space. One residents’ room however, was absolutely full of papers and other items that could potentially present as a fire and tripping hazard. The manager told us; “ The residents have asked for menus that can be displayed within the home”. She confirmed that to date this request has not been met”. Residents we spoke to told us the following about meals; “ The meals are lovely. I am satisfied with them, we have a choice”. “ The meals are good and varied. The only thing is sometimes they are not on time”. “ Meals so far nothing to grumble about. Can not remember if there is a choice”. We observed part the main meal of the day. Food offered consisted of cheese and potato pie , bacon and baked beans. We saw that some residents had chosen leeks instead of baked beans. The pudding was milk macaroni. The meal did look attractive and portions were of a generous size. One resident told us after their meal; “ The food is quite nice”. Another said; “ The food is not nice. Always the same things for dinner”. We were told by a number of people that there were problems with food ordering and deliveries. One person told us; “ If you had come last week there would have not been any food”. Another said “ Last Monday (17 September 2007) we had to contact the owners or there would not have been any meat”. Someone else told us; “ We never get what we order. We try to vary the food but if we order say beef burgers we never get enough for all residents”. We looked at a receipt dated 17 September 2007 this showed that only 12 had been sent 2 boxes of 6. We looked at food stocks and saw that there was frozen meat, plenty of tinned food and cereals. We did see that there was a Two Gates House DS0000066258.V346183.R01.S.doc Version 5.2 Page 19 lack of fresh vegetables and that there was no fresh fruit at all. We were told; “ No there is not any fresh fruit in the home today. We only have this once a week a few pieces”. This is a concern as residents for their health should all be encouraged to eat five portions of fruit or vegetables a day. We saw that there was only two loaves of bread and were told; “ That’s all we have until tomorrow”. We were told that there is not much variety at tea- time. One person told us; “ They told us when they first started that if residents want certain things tell us and we will bring in. The shopping is never right”. “ Not enough to give at tea. Eggs , corned beef and ham. We would like to offer more hot options”. We saw that the majority of milk stored in the home was UHT skimmed milk. We advised the manager that residents’ need to be asked their preferences and health care issues must be taken into account. For instance if someone is loosing weight or has a poor appetite it may be of an advantage to give them full cream milk in order for them to consume more calories. Similarly, residents’ may not all like the taste of UHT milk. This evidence shows that there are some shortfalls regarding food and food provision, which need to be addressed as a matter of urgency to ensure all residents’ can enjoy a varied and healthy diet. Two Gates House DS0000066258.V346183.R01.S.doc Version 5.2 Page 20 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): 16,18. Quality in this outcome area is adequate. Complaints procedures are in place within the home. Residents confirmed that they would approach staff or the manager if they had any complaints. We identified shortfalls concerning safeguarding procedures; which could place residents’ at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints procedure, which is available within the home. The completed Annual Quality Assurance Assessment told us that the home has not received any complaints. We asked that three residents that we spoke to about complaints and got the following answers; “ If I had a complaint I would tell the manager”. “ If I was unhappy or had a complaint I would tell Linda ( the manager). Linda has actually told me if there is anything to let her know”. “ If I had a complaint I would go to the top one and tell them”. A concern form an unknown origin was raised with the Commission. This person made an allegation about a staff member accepting money from a resident in the home. This allegation was passed to the manager for investigation and attention. We were not informed of the outcome of this. Two Gates House DS0000066258.V346183.R01.S.doc Version 5.2 Page 21 During the inspection we asked the manager about the allegation and what had happened. We noted that the home’s annual quality assurance assessment stated that there had been one incident of abuse and wanted to confirm if this was the same as the allegation about money. The manager told us; “ Yes it was the same”. A resident gave a staff member a significant amount of money. “The police were involved and they saw chequebook stubs. The staff member has been dismissed”. We told the manager that we were concerned, as we had not been informed of this outcome, as we should have been. We asked the manager if she had informed social services or the Protection Of Vulnerable Adult ( POVA) list about this incident and the staff member. The manager told us; “ No I haven’t. I thought that the owners would have done. They dealt with the situation. I only knew that the staff member had been dismissed when I asked the owners about it so that I could complete the Annual Quality Assurance Assessment”. We asked the manager to confirm when the staff member had been dismissed. She rang the female owner who could not give a definite date other than July 2007. This evidence shows that although the registered persons had passed this allegation onto the police they had not informed social services, us or the POVA list, of this incident, as they have a legal responsibility to do. Before leaving the home we asked the manager to phone social services to inform them retrospectively of this incident. We asked the three residents’ that we spoke to if they had been treated badly or were aware of any concerns or abuse in the home. We were given the following answers; “ Nothing to me. I have not seen anything”. “ Oh, no nothing like that”. “ Abuse? No nothing”. Two Gates House DS0000066258.V346183.R01.S.doc Version 5.2 Page 22 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): 19,20,24,25,26. Quality in this outcome area is adequate. The home does have some decorating needs which need to be addressed. Living areas are bright and comfortable. Bedrooms meet individual resident preferences. Attention needs to be paid to heating and lighting within the home to make sure that it is adequate. Some improvement is needed concerning infection control processes. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Tow Gates is a detached property located within a residential area of Halesowen. It has a garden area to the rear and a good- sized car park at the Two Gates House DS0000066258.V346183.R01.S.doc Version 5.2 Page 23 front. Within it provides a passenger lift to allow easy and safe access for all residents to both floors. Living space comprises of two rooms. A living area and adjoining dining room. Access to the dining room from the lounge is by way of a ramp. We reminded the manager that this could be a hazard to some residents’ who have impaired mobility and regular risk assessments are needed to reduce risk. We saw that the living and dining rooms are homely and comfortable. One resident told us; “ The lounge area is nice, comfortable”. Furniture is of a good standard and new carpets have recently been fitted. We looked at light fittings in the living areas and saw that all light bulbs were working at that time. Access to the garden is by way of a ramp from the lounge patio doors. We saw a patio area then steps leading to a grassed area. We advised the manager that the steps also need to be risk assessed to prevent risk or accident. The home does have some decorating needs one being the en suite in bedroom 3. The woodwork and walls need redecorating and we saw that the wood behind the toilet cistern is blistered and discoloured. We looked at three bedrooms. The manager told us that she has concerns with one bedroom due to the accumulation of items by the occupier. All three residents’ told us that they were satisfied with their rooms as follows; “ I like my bedroom, everything I need”. “ I am happy with my bedroom. I had a small one when I first came in. They asked me after a while if I would like a bigger room. So I have got a big room now”. We looked at toilets and bathrooms within the home and were concerned to discover by touch that these radiators were not turned on. We discovered that radiators in the hallway were also turned off. We saw that one radiator in the ground floor hallway has been removed. The hallways especially by the front door felt cold. Toilets also felt cold. We discussed this with the manager and pointed out that the colder whether is on its way and that it is her responsibility to ensure that the home is adequately heated. We were told that the new owners also have responsibility for maintenance. We were also told; “ The new owners come in on the weekend, but not every weekend. Sometimes light bulbs go and staff have to change them. We have been told that we have to turn lights off in the corridor at night. We have told them that this is not safe. They have also told us that if M is not in her room her TV must be turned off. It is not often she goes out of her room and if she does it is not for long. It comforts her, her TV being on”. We looked around the home to assess infection control processes. We were pleased to see that a mechanical commode/ urinal washer is provided which ensures effective cleaning of these items and in turn reduces the incidence of infection spread. Two Gates House DS0000066258.V346183.R01.S.doc Version 5.2 Page 24 We were also pleased that we did not detect any unpleasant odours in the rooms that we looked at. We were also pleased to see that liquid soap, paper towels and disposable gloves were available in toilets, bathrooms and the laundry as these measures also prevent infection spread. We did note that there were no signs as there should be in toilets, bathrooms or the laundry reminding residents and others to wash their hands after use. We saw that the laundry is quite small for the size of the home, which does not allow dedicated areas for the storage of clean and dirty laundry. We saw a rack of clean clothes stored in the laundry and explained to the manager that these clothes were very much at risk of catching air bourne spores if there was contaminated laundry in the same room. The sink in the laundry was not clean and there was a lot of clutter. We were surprised to be told that since the new owners have taken over ; “ Cleaning materials are not brought as they were before. Sometimes short of bacterial wipes and bleach toilet cleaner.” If this is the case this situation needs to be reviewed. Two Gates House DS0000066258.V346183.R01.S.doc Version 5.2 Page 25 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): 27,28,29,30. Quality in this outcome area is adequate . The meeting of resident needs may be compromised at times due to low staffing levels. Eleven of the thirteen care staff have achieved NVQ level 2 or above which means that these staff have been assessed as competent to undertake their job roles. Some improvement is needed regarding the recruitment of staff to ensure that residents’ are safe at all times. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at staff rotas, which told us that there are only two care staff on shift at any time. On the day of the inspection we discovered that fifteen residents’ were accommodated, one of whom was very poorly and unfortunately passed away before the inspection ended. One resident has confusion and a short term memory in addition to very restricted mobility and we were told by staff that at least three residents’ require the assistance of two staff. We saw that the two care staff were also doing breakfast and laundry duties, which depleted the low care staff levels further. Additionally. Two Gates House DS0000066258.V346183.R01.S.doc Version 5.2 Page 26 we saw that one of these staff was taken off the floor for at least half an hour to administer the morning medications. We were told; “ There are not enough staff especially at weekends and evenings to do teas and answer buzzers. Residents have to wait. If residents want a bath or shower we have to tell them to wait. We have residents’ such as D,H and M who need two staff. Generally we do try and ensure that residents are looked after- sometimes this is difficult because of staffing levels”. Someone else told us; “ They need to rotate shifts. Some do same, it is not fair on others”. One resident told us; “ We could do with more ( staff)”. We spoke to the manager about our concerns regarding staffing levels. The manager told us; “ Two staff are enough. I see them sitting down sometimes”. We reminded her that if this was the case, then it was all of the registered persons’ responsibilities to adequately manage the staff and their time properly. The completed AQAA told us that eleven of the thirteen care staff have achieved NVQ level 2 or above. It is very positive that eleven of the thirteen care staff have achieved NVQ level 2 or above as this means that they have been assessed as competent to undertake their job role. That staff have actually achieved their NVQ’s was further confirmed by the staff when we spoke to them and the home’s training matrix. We looked at three staff files. All but one of these have been employed for some time. We did identify shortfalls in the recruitment of the last staff member to be employed on 4.5.07 as follows; The only employment history provided was 11/06-07, nothing previous. Although a clear Criminal Records Bureau check was now available, this staff member had been taken on, on a POVA first dated 2.5.07. We asked the manager to provide evidence of a risk assessment for this person and the named supervisor for her when she first started, these processes must be put in place to prevent risk to residents’. The manager could not provide us of evidence of these. We told the manager that we had no evidence to confirm that we had been informed that this staff member was being employed on a POVA first as should happen. Again the manager was not able to provide us with evidence to confirm that this action had been taken. We spoke to four staff who all told us that their training was up to date. This was confirmed further by the home’s training matrix. Although we saw that there were a few gaps such as; Control Of Substances Hazardous to Health (COSHH) training for three staff, infection control for two staff and abuse training for two staff, generally evidence indicates that training is satisfactory. Two Gates House DS0000066258.V346183.R01.S.doc Version 5.2 Page 27 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): 31,33,35,36,38. Quality in this outcome area is poor. Management arrangements within the home are not effective and potentially place residents’ at risk. More development is needed to ensure that quality assurance and monitoring processes within the home are effective and ensure that the home is run in the best interests of the residents’. Some further development and improvement is needed to ensure that all levels of staff are appropriately supervised and supported. Health and safety concerns within the home need to be addressed to prevent risk to the residents’. This judgement has been made using available evidence including a visit to this service. Two Gates House DS0000066258.V346183.R01.S.doc Version 5.2 Page 28 EVIDENCE: The manager LS told us that she was having some difficulties due to the change of ownership of the home. The manager told us that; “ The previous owner had taken a lot of responsibility for the running of the home, decision making and administration tasks”. She said; “Now I do it all and in some areas such as the completion of your questionnaire it is all new to me”. We were concerned about the management of the situation of the dismissed staff member and the allegation of financial abuse. The manager LS told us; “ I thought they were dealing with all that and that as I had been a witness I could not be involved”. We looked at the off duty and for example; saw on week 24-30 September 2007 the manager was days off on Saturday and Sunday. As we had been told by staff and the manager that the owners only visit on a weekend we asked the manager to confirm how often she actually sees the owners. The manager showed us some meeting minutes from 3.3 2007 and confirmed that she had only seen the owners face to face once since then. This evidence shows that the manager has undertaken a change of responsibility since the new owners have purchased the home and needs additional support and guidance. Responsibilities need to be discussed and be clear to all parties to prevent further shortfalls. During the inspection We heard the managers mobile phone ‘bleeping’ and asked what that was. We were told; “It is the owner. He wants me to give you a message”. We insisted she tell us what the message was. The manager told us; “ If they ask about communication between us tell them we talk or text daily”. We had further concerns about the management arrangements for the home when the manager is off duty. We spoke to two staff who told us they were employed as carers. We looked at the off duty for week 24-30 September2007 and saw that there was no name showing who had senior responsibility for the home that evening. We asked the manager about this and was told; “ They do not like their names to go on the rota as senior as they would then have that responsibility”. We told the manager LS that this was unacceptable and it was for the registered persons to manage. A named competent senior must be in charge of the home when she is not there. We looked at the terms and conditions documents for these staff members, which clearly stated that they were ‘ care’ not ‘senior’ care staff. We were further concerned as we remembered when we first entered the home and asked who was in charge one carer said; “ That is me until the manager comes in”. We asked the manager about this staff member and was Two Gates House DS0000066258.V346183.R01.S.doc Version 5.2 Page 29 told; “ There were problems. Used to be a senior could not carry on with role as she was making too many mistakes”. We told the manager that when we came to the home this morning before you arrived she told us that she was in charge and you leave her in charge at weekends even though you know she makes mistakes? The manager told us; “ Yes she was in charge this morning and weekends. Its just that she does not have confidence”. The manager told us that there were two nominated seniors. We looked at the file of one and were further concerned. A letter on file dated July 2006 about her not being suitable for senior. The staff member appealed and was sent a letter dated 9.11.06 from the owners to confirm they were giving her a rise and waivering her 3 month probationary period. We asked LS to confirm the present situation with this senior and she told us; “ Doubts about her competence as senior. Makes occasional mistakes – forgetting to sign for medication”. The manager showed us her system she was using for the quality monitoring within the home. Although on paper the system looked effective the shortfalls identified during this one inspection day alone told us they were not. IT is positive however, that the manager was able to show us documentary evidence that questionnaires had been issued to a range of professionals and had completed these. Concern was raised in the last inspection report dated 1 February 2007 about the lack of quality monitoring by the new owners and infrequent Regulation 26 being produced. A requirement was made in this report concerning this shortfall. We looked at records and saw that reports are still not being completed every month. Again the managers phone ‘ bleeped’ we asked what the message was this time. The manager confirmed that it was from the male owner and it read; “ If they ask make it clear we are in every weekend”. “ Tell them to ask residents try I”. We informed that manager that even if this is the case there is no evidence of monthly reports or of quality monitoring. We looked at money held in safekeeping by the home. This was accurate against balances. We did see however, that for chiropody official receipts are not being given. We looked at four staff files. We saw that there was evidence of supervision and appraisal but the overall amount do not total the required six in any twelve month period. Due to evidence gained during the inspection we asked the manager to confirm if she has structured one to one supervision from the owners and if she could provide evidence of such. The manager told us; “ No I do not have one to one supervision. The only record of meeting is the one I showed you before on 3.3.07”. Two Gates House DS0000066258.V346183.R01.S.doc Version 5.2 Page 30 West Midlands Fire Service carried out an inspection of the home on 29 August 2007 and found that there were some concerns. Following this and communication from the home to the fire service, the fire service issued another letter dated 18 September saying that; the Fire and Rescue Authority is now of the opinion that the fire that the fire precautions inspected at that time were satisfactory. We looked at training and saw that all staff have at some point received fire training in 2007. We were concerned however, to see that bedroom doors 16 and 17 are not closing properly into their rebates. We highlighted this concern to the manager LS during our inspection. We were also concerned that radiators for example in bedrooms 3,16 and 17, ground floor toilets, the bathroom and ground floor corridors were not guarded. The manager told us; “ The ones in the bathroom and toilets are not guarded as the residents use these to pull themselves up”. We told her that this was unsafe as radiators are not for this purpose. We were surprised to see that there were grab rails on the wall above the radiator in the toilet next to the office and the ground floor bathroom- so could not understand why we had been told this by the manager. The manager further told us; residents do not want covers on their radiators. I looked at RG file and saw that he had signed a paper in 2005 saying that he did not want a cover on his radiator. We told the manager that this is for the registered persons to manage. National minimum standard 25.5 states; ‘Pipe work and radiators are guarded or have low temperature surfaces’. We also noted from the home’s Annual Quality Assurance Assessment confirmation made by the manager that 3 new residents had been admitted in the last 12 months. We told the manager that radiators must be guarded starting with high risk and that when bedrooms became available this should have been addressed. We were concerned that the bedrails in room 3 were loose and that there was no written evidence to confirm that daily checks are being carried out to avoid the risk of accident or limb entrapment. We were concerned that a requirement made in the last Environmental Health report for the repainting of the kitchen ceiling has not been addressed, even though a requirement was also made in our last inspection report dated 1 February 2007 regarding the same. We found a number of shortfalls in the kitchen as follows; There were no food delivery temperatures. Two bottles of sauces were dated longer than 6 weeks previously and should have been discarded. We saw care staff walking in and out of the kitchen not wearing protective clothing. The kitchen lacks a first aid box. Two Gates House DS0000066258.V346183.R01.S.doc Version 5.2 Page 31 We saw that there were two ‘ kitchen diaries’ on the shelf in the office, which had been given by Environmental Health but were not being used as recommended. Two Gates House DS0000066258.V346183.R01.S.doc Version 5.2 Page 32 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 2 3 x x x 3 2 2 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 x 1 x 2 2 x 2 Two Gates House DS0000066258.V346183.R01.S.doc Version 5.2 Page 33 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 OP8 Regulation 13(4)( c) Timescale for action Risk assessments and monitoring 24/10/07 concerning tissue viability, nutrition, falls and any other areas of concern must be carried out with adequate frequency. Findings from these assessments must be reflected in care plans to give staff clear instruction on how they should manage each area. This requirement has been made to make sure that residents are safe and protected from risk. 2 OP9 13(2) Medication boxes and packets 24/10/07 must be date labelled when first used to enable effective audits to be carried out. All medications coming into the home must be counted and recorded. This requirement has been made to increase medication safety and prevent risk to residents. Two Gates House DS0000066258.V346183.R01.S.doc Version 5.2 Page 34 Requirement 3 OP9 13(2) This requirement was highlighted verbally to the manager during the inspection. Staff must follow full 25/09/07 administration guidance for Allendronic Acid. This requirement has been made to increase medication safety and prevent risk to residents. This requirement was highlighted verbally to the manager during the inspection. 4 OP9 13(2) Medication care plans must be produced for each resident. These must include all information concerning administration, side effects and other issues . Clear instructions must be produced for medications prescribed on an ‘ as needed’ basis such as Promazine. This requirement has been made to increase medication safety and prevent risk to residents. This requirement was highlighted verbally to the manager during the inspection. 24/10/07 5 OP9 13(2) Risk assessments must be produced for any resident who self medicates or manages their own medication this to include oral and topical preparations. This requirement has been made to increase medication safety and prevent risk to residents. 24/10/07 Two Gates House DS0000066258.V346183.R01.S.doc Version 5.2 Page 35 This requirement was highlighted verbally to the manager during the inspection. OP18 6 13(6) All allegations or incidence of abuse must be reported to Social Services in accordance with multi-agency protection procedures. CSCI must be informed of any allegations or incidence of abuse in accordance with Regulation 37. Where staff are suspended or dismissed a referral to the Protection Of Vulnerable Adults (POVA) list must be made without delay. This requirement has been made to prevent abuse and keep residents safe. Evidence that this has been done must be provided to the CSCI by 01/11/07 This requirement was highlighted to the manager during the inspection. A review of staffing levels must 15/11/07 be undertaken. Staffing levels should be increased. This requirement has been made to make sure that resident needs are met and that they are safe. 8 OP31 18(1)(a) Evidence must be available at all times to demonstrate that seniors in charge per shift are competent. A named senior must be appointed for each shift. Their name must be detailed on the DS0000066258.V346183.R01.S.doc 24/09/07 7 OP27 18(1)(a) 01/11/07 Two Gates House Version 5.2 Page 36 rota. This requirement has been made to make sure that resident needs are met and that they are safe. 9 OP33 26 The owner must ensure that visits to the home take place on a monthly basis as required by regulation 26 and that suitable reports are produced Timescale of 01/05/07 not met. 10 OP38 23 The manager must ensure that all work required in the last report of the environmental services officer is completed. Timescale of 01/06/07 not fully met. 11 OP38 13(4)( c) Radiators within the home must be suitably guarded. In the interim adequate measures must be taken to prevent risk to residents. 01/12/07 01/11/07 01/11/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP2 Good Practice Recommendations We strongly recommend that terms and condition documents are valid and up to date for example; they must show the present fee rates. Full fee rate should be shown not just ‘ LA’ rate. We strongly recommend that care plans be produced to DS0000066258.V346183.R01.S.doc Version 5.2 Page 37 2 OP7 Two Gates House 3 4 5 6 7 OP8 OP8 OP9 OP9 OP9 8 OP9 9 10 OP9 OP12 11 12 OP12 OP15 reflect the full care needs, goals and risks for each resident. Care plans must incorporate in detail needs such as those relating to cognitive impairment and dementia. We strongly recommend to decrease risk and effectively monitor health that all residents be weighed monthly and that these weights be recorded. We strongly recommend that a set of sit on scales is purchased to ensure that resident weights can be accurately monitored safely. It is strongly recommended that where medication records are handwritten two staff verify that the information is correct. It is strongly recommended that the medication records detail any allergies or non allergies. It is strongly recommended that where a variable dose is prescribed for example; one or two that residents are given the choice and that the number given each time is recorded on the medication record. It is strongly recommended that a thermometer be placed in the medication trolley and twice daily temperatures are taken and recorded. If the temperature exceeds 25oc then an alternative storage area for the trolley must be found. The manager must ask the doctor to approve in writing preparations that are being taken by residents’ as ‘ homely remedies’. We strongly recommend that an activities needs and leisure time analysis is undertaken concerning all residents. From this a structured activity programme should be produced with activities and leisure time pursuits provided as per needs identified. A schedule of resident meetings should be produced. Meetings should be held on a regular basis. It is strongly recommended that the ordering and delivery of food processes is revised as a matter of priority to ensure that; Food needed in the home is available in adequate quantities at all times. That milk choices are given depending on personal preferences and medical/nutritional need. That fresh fruit and vegetables are available at all times. A review of meals should be undertaken to ensure that meals offered are varied . Menus should be widely available within the home for residents to access. A review of infection control processes should be DS0000066258.V346183.R01.S.doc Version 5.2 Page 38 13 OP15 14 OP26 Two Gates House undertaken paying particular attention to the laundry to ensure that; The laundry is free from clutter. The sink is clean at all times. Handwash signs should be provided in all toilets and bathrooms and other high risk areas. It is strongly recommended that cleaning and laundry staff are provided each day. These must be provided in addition to care hours. It is strongly recommended that the registered providers do a full review of management responsibilities in the home. That the manager receives structured one to one supervision on a regular basis. That the manager is supported and given training in areas identified as her ‘ learning needs’. The manager should ensure that there are effective systems for quality monitoring and quality assurance, which take account of the views of residents and other stakeholders and form the basis for annual development planning. An official receipt should be available to confirm all expenditure of residents money held in safe keeping- for example the chiropodist. It is strongly recommended that a first aid box is provided in the kitchen. 15 16 OP27 OP31 17 OP33 18 19 OP35 OP38 Two Gates House DS0000066258.V346183.R01.S.doc Version 5.2 Page 39 Commission for Social Care Inspection Halesowen Records Management Unit West Point Mucklow Office Park Mucklow Hill Halesowen B62 8DA 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 Two Gates House DS0000066258.V346183.R01.S.doc Version 5.2 Page 40 - 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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