Inspection on 14/11/07 for Urmston Cottage

This inspection was carried out on 14th November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Urmston Cottage 25/03/10

Urmston Cottage 19/01/10

Urmston Cottage 07/05/09

Urmston Cottage 08/09/08

Urmston Cottage 07/04/08

Urmston Cottage 16/10/06

Urmston Cottage 17/03/06

Urmston Cottage 10/11/05

Urmston Cottage 23/09/04

Urmston Cottage 15/04/04

Urmston Cottage 21/10/03

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

CARE HOMES FOR OLDER PEOPLE Urmston Cottage Greenfield Avenue Urmston Manchester M41 0XN Lead Inspector Sylvia Brown Unannounced Inspection 14th November 2007 10:00 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 Urmston Cottage DS0000006729.V354897.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. Urmston Cottage DS0000006729.V354897.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Urmston Cottage Address Greenfield Avenue Urmston Manchester M41 0XN 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) 0161 747 3738 no fax Urmston Cottage (Mcr) Ltd Mrs Marguerite Wendy Thomas Care Home 45 Category(ies) of Old age, not falling within any other category registration, with number (44), Physical disability (1) of places Urmston Cottage DS0000006729.V354897.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Service users shall be aged over 60 years except for one named person who requires nursing care by reason of physical disability. A maximum of 25 service users who require general nursing care can be accommodated. Staffing levels as specified in the Section 13 (5) Notice dated 9 August 2005, shall be maintained. 16th October 2006 Date of last inspection Brief Description of the Service: Urmston Cottage is an extended Victorian property offering care and accommodation with nursing support to 45 residents. There are several lounges and a dining area for residents’ communal use. Bedroom accommodation is on two floors and is for single and double occupancy. Some bedrooms have en-suite facilities. A passenger lift supports residents to reach all parts of the home. There are gardens to the rear of the property, which are well used in fine weather and parking space is available to the side of the home. The home is near the centre of Urmston, close to a number of shops and market place. It is close to local bus routes and the Metrolink. The current fees for the home range from £344 to £540 per weeks. Fees are dependant on care need support and individual funding arrangements. Urmston Cottage DS0000006729.V354897.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Since the last inspection we have completed an Annual Service Review (ASR), which helps us to assure ourselves that the service is still performing as well as when we did the last key inspection. An ASR is part of our regulatory activity and is an assessment of our current knowledge of a service, rather than an inspection. We only do an annual service review for ‘good’ or ‘excellent’ services that have not had a key inspection in the last year. If the outcome of an ASR leads us to believe that the there have been significant changes within the home which may affect its current rating, we can bring forward the key inspection, which is what we have done for Urmston Cottage. The ASR identified that there might be a downward change at the home and, as a consequence, the key inspection was thought necessary to ensure that standards were maintained for the benefit of residents. This key unannounced inspection, which included a site visit, took place on Wednesday, 14th November 2007. The manager of the home was not told beforehand of the inspection visit. All key inspection standards were assessed at the site visit and information was taken from various sources which included: observing care practices and talking with people who live at the home, visitors, the manager and other members of the staff team. Before the site visit, and as part of the overall key inspection process, we sent the manager an Annual Quality Assurance Assessment (AQAA), which is a selfassessment completed once a year by all providers, whatever their quality rating. It is one of the main ways that the Commission for Social Care Inspection (CSCI) will get information from providers about how they are meeting outcomes for people using their service. We asked the manager to complete the AQAA and tell us what she thought they did well and what they need to improve on. The returned AQAA was not very detailed and did not tell us a lot about what has happened in the service over the last 12 months. We considered the responses and information the manager provided and have referred to this in the report. Two residents were looked at in detail, and we considered their experience of the home from their admission to the present day. Urmston Cottage DS0000006729.V354897.R01.S.doc Version 5.2 Page 6 A tour of the building was conducted and a selection of staff and care records was examined, including employment and training records, staff duty rotas and residents’ care plans. We also assessed the arrangements the home had in place for dealing with medicines. Since the last inspection, a new manager has been appointed. We were not formally told about the change in the management team, which also included the deputy manager. The manager commenced employment in August and, at the time of reporting, no application had been received to commence the registration process for the manager. What the service does well: What has improved since the last inspection? Since the previous inspection the registered person has continued to upgrade the home, with attention being paid to the private areas used by residents. There are plans underway to develop all parts of the home in the near future. The manager told us new systems have been introduced which give residents more control over their own lives and daily routines. Residents can now rise when they like and receive their bathing support as they desire, rather than to fit into staffing routines. Urmston Cottage DS0000006729.V354897.R01.S.doc Version 5.2 Page 7 What they could do better: It is a regulatory requirement that care homes are run by a managers who have been appropriately recruited and selected, and who must be registered by us as a fit person to run a care home. The registered person has not made sure these steps, which are for the protection of vulnerable adults, have taken place. In addition, inspection of staff files identified that robust recruitment procedures had not been followed. The home must improve its recruitment and selection procedures. Current practice places residents at increased risk of receiving support from people who may do them harm. One relative told us residents were left for long periods without staff supervision. This was also observed at the site visit. Staff should be deployed around the home and systems introduced to make sure residents are not left unattended for long periods of time. There have been significant staff changes over the last 12 months, which means residents have to keep getting to know the people supporting them and continually have to keep forming new relationships. Action should be taken to reduce staff turnover, in order to provide residents with a stable staff team who they are able to get to know and trust. Infection control procedures should be carried out, where possible, discreetly, ensuring attention is not drawn to any particular resident. The home’s statement of purpose and service user guide should be reviewed and updated to make sure prospective and current residents receive up to date and accurate information about the home and services offered. Service users’ plans could be further developed to ensure that all their individual needs are recorded, how they should be met and by whom. This means residents receive the support they want and need, and staff know how that support should be given. In order to make sure residents receive their medication as prescribed, all prescribed medication, including creams, should be signed for when administered. The home should also make sure that medication is stored at the appropriate temperature. To support residents who have movement difficulties when eating, the home should make sure there is adapted crockery and cutlery available to support them at meal times. The home should ensure that all areas used by residents are sufficiently bright. The home should prioritise lighting in bedrooms to make sure it is suitable to meet the individual needs of all residents. Urmston Cottage DS0000006729.V354897.R01.S.doc Version 5.2 Page 8 In order to make sure residents, relatives, staff and stakeholders are consulted about the service, quality assurance procedures should be conducted, as required within the Care Homes Regulations and as detailed within the National Minimum Standards. When completed, a report of the outcome should be published and a copy of the report submitted to us. The manager should ensure that they keep us appropriately informed of all significant events within the home, as stated within Regulation 37. The enables us to monitor the conduct of the home when significant events happen which may affect the health and well being of a resident. 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. Urmston Cottage DS0000006729.V354897.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 Urmston Cottage DS0000006729.V354897.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. Standard 6 is not relevant to this service. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Prospective residents are able to receive information about the home and have their needs assessed prior to making any decisions about moving into the home. EVIDENCE: The home has a written pre-admission procedure which makes sure that those residents who are privately funded have their needs assessed and an opportunity to meet with someone from the home prior to admission. Best practice would be to extend this procedure to all prospective residents. The manager told us there had been no new admissions since she started at the home. The last key inspection judged the previous manager’s preadmission procedures as good. Urmston Cottage DS0000006729.V354897.R01.S.doc Version 5.2 Page 11 Of the care files looked at, it was evident that those residents receiving support from the Local Authority had their needs assessed prior to admission. The home’s statement of purpose and service user guide need to be reviewed as some information is incorrect and/or out of date, for example, the statement of purpose records the new manager, whilst the service user guide details the previous manager. Urmston Cottage DS0000006729.V354897.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. Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Residents’ health and personal care needs were met; however, care plans need developing to demonstrate how this was being achieved. EVIDENCE: All residents have a written care plan in place. Whilst the plans detailed the residents’ need for support they were not sufficiently detailed to inform the reader of specific needs or how they should be met. For example, one care plan stated ‘needs assistance with personal care’, ‘ensure dry and clean’ and ‘provide mouth, eye and skin care.’ Records should be detailed and individualised to ensure staff know what the needs are and how they should be met. Three residents’ records were looked at; there was no indication of toileting programmes or individualised support. One stated, “take to toilet regularly”. Urmston Cottage DS0000006729.V354897.R01.S.doc Version 5.2 Page 13 Daily records were brief and repetitive, further diminishing the individuality of residents. Comments such as ‘fine today’, ‘eat well’ and ‘no problems’ do not demonstrate the individualised care support provided or reflect the daily life, routines and achievements of residents. The manager told us she had recognised that further details were required and that she was working towards developing better recording systems. Records confirmed that residents receive visits from health care professionals, as they require. Medication recording systems were looked at, as were management systems for stored medication. The room where medication was stored was found to be excessively warm on the day of the site visit. There was no ventilation in the room and no windows to enable the cooling of air. Medication is best stored below certain temperatures, therefore action should be taken to monitor and maintain the temperature in rooms where medication is stored. Medicines stored within the medication refrigerator were appropriately stored, as were controlled medications. Medication administration records were, in the main, well kept, except for the practice of not signing when prescribed creams were administered, particularly when care staff administered the creams. The home has not trained care staff to enable them to sign for medication they have administered. One resident’s record failed to record that eye drops were being administered. When asked about the support they received, residents spoken to were, in the main, satisfied with the service. One resident told us ‘everything is very nice, they don’t make a fuss, they just get on with it’ and another said, “they are nice, they look after us well”. Urmston Cottage DS0000006729.V354897.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): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents maintain contact with family and friends and were able to exercise choice and control over their lives. They received choice at mealtimes and were able to meet with others to socialise. EVIDENCE: Residents at Urmston Cottage are supported to enjoy their lives and socialise. They have opportunities to join in a variety of activities. A family committee takes an active lead in developing and providing activities in and outside of the home. One committee member spoken to was enthusiastic about the planned social events for the winter season and gave many instances where attempts had been made to involve all residents living at the home. Through December, residents have the opportunity of visiting restaurants, joining in the home’s Christmas fair, listen to the local children when they visit to sing carols, join in a school party, listen to bell ringers as they entertain at the home and join in the home’s own Christmas party. Urmston Cottage DS0000006729.V354897.R01.S.doc Version 5.2 Page 15 It is the home’s intention to open a ‘shop’ which is run by the residents and which promotes their independent shopping. Information received from the provider’s visits, confirmed that residents had recently joined in a cheese and wine evening and other events. During the course of the site visit, it was observed that some residents with higher dependency were left without occupation or stimulation in one lounge. There was no structured plan in place to provide specialised activities or socialise with this group of residents. The manager stated that consideration is being given to employing an activities co-ordinator, who will have responsibility to ensure all residents have their social needs assessed and, as far as possible, individually met. There was evidence that staff are able to meet the diverse needs of the service users, in particular, in relation to religious observance. A number of residents attend church services in the community and for those who are unable to go out, ministers from various faiths visit the home on a regular basis. When asked what the home did well, one relative told us “the home makes a big effort to celebrate festivals and traditions” and that “outings are arranged to interesting places”. They also told us that “the home is very supportive of spiritual beliefs” and ensures residents have the opportunity to share communion as they desire. One resident informed the inspector that they attend mass and feel they are well supported to continue with their faith. The main cook told us she meets with residents daily and finds out what they would like to eat from the day’s menu. She was knowledgeable about their individual requirements and had their best interests in mind. She understood the pleasure good meals and mealtimes bring to residents, as well as recognising the health benefits. A full variety of foods were served and, although the menu was not kept to, there was clear evidence why. For example, one service user was heard to say they would like liver. After asking with others who also said they would like it, the cook ordered the meat and amended the next day’s menu accordingly. Hot food items, such as bacon and eggs, are available at breakfast; suppers are also varied. The cook stated that those residents who require soft food items rarely receive meals different than anyone else and they are individually liquidised and presented in a nice manner. Food preparation was observed and it was evidenced that those residents who have diabetes receive, more often than not, the same sweet as others. Fresh fish is served twice weekly and fresh fruit daily. Urmston Cottage DS0000006729.V354897.R01.S.doc Version 5.2 Page 16 One mealtime was observed. The residents enjoyed the meals served; staff offered differing sized portions and asked what people would like, i.e., all vegetables or some vegetables, etc. Two residents who had difficulty in movement were observed eating from plates where their food had slid off. Neither had been supported to have adapted crockery or cutlery which the manager said was readily available. One resident was also observed sat in a wheelchair in a corridor eating her meal. It was clear that time had been taken to ensure she was appropriately prepared, however there was no reason given by staff as to why the resident was isolated and ate alone. The home had an open visiting policy and visitors could be seen in the privacy of residents’ own rooms or in any of the communal areas. Urmston Cottage DS0000006729.V354897.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): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Residents’ complaints are taken seriously and they are safeguarded by adult protection procedures. EVIDENCE: The home has a written complaints procedure which is made known to residents and visitors. The manager said that prior to her employment complaints were not formally recorded. She has developed a recording system which identified that she had received one complaint from a visitor and several by staff at a staff meeting. There was clear information about the complaints and the action taken to resolve them. We have received instances where the general public have contacted us regarding the conduct of the home. One person felt the conditions of the home were not as stated within our last inspection report and another stated that the previous manager had responded negatively to receiving a complaint. They said “it was stressful”. One relative stated that the new manager has acted “immediately and to everyone’s satisfaction” when an issue was brought to her attention. Urmston Cottage DS0000006729.V354897.R01.S.doc Version 5.2 Page 18 The home had an Adult Protection Policy and Procedure in line with the Local Authority’s procedures. The manager stated that she was currently reviewing staff training and development of records and that, to her knowledge, all staff have received appropriate in safeguarding vulnerable adults. Urmston Cottage DS0000006729.V354897.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): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents live in pleasant comfortable and safe surroundings. EVIDENCE: Residents were observed in a number of lounges; all were clean and tidy, however some service users did not have side-tables and were observed asleep with cups in their hands, with two residents asleep with cups with tea in them on their knees. Some service users were asleep in awkward positions and would have benefited from cushions to rest their heads on. Urmston Cottage DS0000006729.V354897.R01.S.doc Version 5.2 Page 20 The home continues to invest in the environment for residents. Toilets and bathing areas have been upgraded to a good standard and lounges and dining areas have been measured for new curtains. The manager stated bedding and new furniture has also been ordered for residents’ rooms. The manager stated she was aware that communal areas needed upgrading and said that currently residents’ personal rooms were being prioritised. However, a review of fixtures and fittings within communal areas should be undertaken in a timely manner. One relative informed us that at least one armchair is faulty and places residents at an increased risk of accident. Communal areas have received new lighting, which is appropriately bright. Three bedrooms were looked at and were appropriately personalised and reflected the residents’ individuality. It was observed that long-life bulbs were sticking out of light fittings, particularly wall and overhead lights. This is not only unsightly, it does not afford residents eye protection and may cause discomfort. One resident’s bedside light was observed to be without a bulb. Two other bedrooms were observed to be poorly lit, in that, lighting was low and gloomy. Long-life bulbs are not always sufficiently bright enough to meet the needs of failing eyesight, particularly in older people. In one part of the home, a stack of plastic aprons, yellow and red bags, gloves and wipes were placed outside a resident’s room. It was clear that infection control procedures were in place; however, such procedures should be carried out more discreetly and, where possible, without drawing attention to any one resident. On the day of the site visit, carpet cleaning was in progress and the home was free from odours. Urmston Cottage DS0000006729.V354897.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): 27, 28, 29 & 30 Quality in this outcome area is poor. This judgement has been made using available evidence, including a visit to this service. Residents are placed at increased risk of receiving care from people who may do them harm because of poor recruitment procedures. EVIDENCE: In order to ensure the home was operating robust recruitment and selection procedures, four staff files, including the manager’s, were looked at. It was identified that the home did not follow statutory procedures when recruiting some staff. Of the four staff files looked at, one application was signed but undated, two people had commenced employment without CRB or POVA First checks being received. References for one staff member were not in relation to Urmston Cottage, two records could not evidence staff attendance at interviews and letters of appointment were not in place for three staff. Staff probationary periods could not be established, nor could the procedure of induction be evidenced. Through not following correct procedures, residents may be at risk of receiving support from people who may do them harm. Urmston Cottage DS0000006729.V354897.R01.S.doc Version 5.2 Page 22 The staffing rota identified the correct details, in that, staff names and positions were clear, as were their hours of work. Staff were in sufficient number to meet the current needs of residents at the time of the site visit. One relative made a comment about the high proportion of overseas staff and the difficulty, at times, of understanding them. They expressed concerns regarding how this may also affect residents. Another relative told us that sometimes residents were left for long periods of time in lounges and bedrooms without staff observing them. The organisation does recruit staff from overseas and uses them in a care assistant position during their adaptation training. The manager then told us the staff are then moved on to other homes in the company. The AQAA stated that within the last 12 months 43 full-time staff have left employment at the home. This is extremely high and is of some concern. Such a turnover of staff means residents are more likely to receive care from people they do not know or trust. The rota indicated that 14 of the 34 staff are from overseas. One relative stated that there is some difficulty understanding language and dialects, as staff are from various countries. The manager said she has recognised this and in an effort to support both the home and the staff, she has provided access to English speaking training. During the site visit, the inspector had to support one resident to receive a second drink as they mistook the inspector for a member of staff. As also stated, residents sleeping with cups in their hand were left unnoticed for long periods of time. The home should review how staff are deployed within the home. The AQAA stated that staff receive training from their own company and through the Local Authority’s training programme. Furthermore, it stated that new staff complete a 12-week induction course that fulfils the Skills for Care Common induction requirements. Urmston Cottage DS0000006729.V354897.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): Quality in this outcome area is poor. This judgement has been made using available evidence, including a visit to this service. Residents live in a home whose manager was not appropriately recruited and who is not registered with us. EVIDENCE: There have been significant changes in the management team since the last inspection that we were not told about. Records looked at identified that the manager was not recruited correctly and, although employed since August 2007, has not applied for registration with us. Urmston Cottage DS0000006729.V354897.R01.S.doc Version 5.2 Page 24 The change in management has not been without difficulties and has impacted on staff and relatives. The manager said that the changeover was difficult for everyone, and was not necessarily handled correctly, in that, the previous manager had left before she commenced employment. The manager told us this meant there was no-one in management with full knowledge of residents or how the home was previously managed. One relative spoken with said that the whole atmosphere within the home had changed and that some things are done differently and even better than before, however it has caused unrest with the staff and has created some difficulties. The manager told us that in addition to senior management changes, a significant number of staff with knowledge of the home were moved to another home within the company. This was due to their achievements in completing adaptation. The manager said that staff morale is now good and that they have worked though initial difficulties. Staff meetings have been held, as have supervisions that have enabled staff to voice their opinions. One staff survey was returned which told us that the staff member usually received enough support to do their job and that the manager sometimes met with them to discuss their work. Initially, the AQAA did not detail when procedures were last reviewed, however, after being requested to do so, the manager completed this information at the time of the site visit. The manager confirmed that appropriate servicing of equipment had been carried out in 2007 and that lifts, central heating and gas appliances had been serviced by external agencies. The registered person has commenced Regulation 26 visits and provided us with a report. The document was detailed and identified that there had been an open evening to introduce the new management team to relatives. It further identified that a new member of staff chaired the staff meeting, however when asked about this person, the manager stated she was not employed at the home, indicating that she was a previous work colleague and friend visiting the home. It is unclear why the manager denied that this staff was working and/or employed at the home. The home has not completed quality assurance procedures in accordance with Standard 33 and Regulation 24, which ensures that residents, relatives, staff and stakeholders’ views are sought on the services offered at the home. Urmston Cottage DS0000006729.V354897.R01.S.doc Version 5.2 Page 25 One relative told us that they are not always informed of accidents when they have occurred and that though they know accidents should be recorded, they have never had access to such records or obtained full details of how accidents happened. Accident records were looked at and were found to be brief. Details should reflect more accurately the accident, where it is known, and the full action taken by the home. A number of residents have attended hospital due to falls, however the home has not kept us fully informed of those instances in accordance with Regulation 37. The inspector was informed of one accident where a resident fell down a flight of stairs and, whilst no injuries occurred, they failed to notify us as required. The relative told us that although a safety lock has been fitted on the door leading to the basement, staff do not always make sure it is secured. Furthermore, the cook told us that there had been widespread infection within the home, which had led to most residents having diarrhoea. We were not told about this prior to our site visit. A sample of residents’ income and expenditure records were looked at and balances audited. They were found to be correct at the time of the site visit. Urmston Cottage DS0000006729.V354897.R01.S.doc Version 5.2 Page 26 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 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 x 1 x 3 x 3 3 Urmston Cottage DS0000006729.V354897.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No 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 OP29 Regulation 8,19 & Schedule 2 Part II of the Care Standards Act 2000 19 3 OP31 Reg 37 Requirement For the protection of vulnerable adults, robust recruitment and selection procedures must be followed at all times. The home must be managed and run by a person who has been confirmed by us as a fit person to run a care home. An application to register must be submitted to us without delay. The registered person must keep us informed of all significant events within the home, which may affect people who are living there. Timescale for action 15/11/07 2 OP31 15/11/07 15/11/07 Urmston Cottage DS0000006729.V354897.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 Refer to Standard OP1 OP7 OP9 Good Practice Recommendations The home’s statement of purpose and service user guide should be kept under review and contain up to date, current information . The care plans should be reviewed to ensure the assessed care needs of people living at the home are clear and staff are aware of how to meet those needs. The medication records must be signed when medication, including creams, is given to the people living at the home so that all staff are aware that it has been administered to the right person at the right time and correctly. Systems should be in place to ensure all medication is stored at the correct temperature as detailed by the manufacturer. Systems should be introduced which makes sure that the most highly dependent residents have the opportunity for social stimulation. People who use the service should have access to and be provided with adapted cutlery and crockery to suit their individual needs. All areas of the home should be appropriately lit and lighting sufficient to meet the individual requirements of people living at the home. People living at the home should have access to sidetables and cushions to improve their comfort and safety. Infection control procedures should be carried out discreetly and, where possible, without drawing attention to any one person. Action should be taken to actively reduce the turnover of staff. Staff should be appropriately deployed in all areas used by people living at the home, to make sure they are appropriately supervised and support. Quality assurance procedures should be carried out, with a public report being produced about the outcome. A copy of which should be supplied to us. 4 5 6 7 8 9 10 11 12 OP9 OP12 OP15 OP21 OP21 OP26 OP27 OP27 OP33 Urmston Cottage DS0000006729.V354897.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Manchester Local Office 11th Floor, West Point 501 Chester Road Old Trafford Manchester M16 9HU 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 Urmston Cottage DS0000006729.V354897.R01.S.doc Version 5.2 Page 30 - 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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