Inspection on 02/08/06 for Venn House

This inspection was carried out on 2nd August 2006.

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

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

Other inspections for this house

Venn House 02/10/08

Venn House 01/10/07

Venn House 04/04/07

Venn House 01/03/06

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

CARE HOMES FOR OLDER PEOPLE Venn House Lamerton Tavistock Devon PL19 8RX Lead Inspector Helen Tworkowski Unannounced Inspection 09:30 2 August 2006 nd 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 Venn House DS0000065984.V301931.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. Venn House DS0000065984.V301931.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Venn House Address Lamerton Tavistock Devon PL19 8RX 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) 01822 612322 0870 1270388 Venn Care Ltd Vacancy Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places Venn House DS0000065984.V301931.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. To accommodate one named individual in the category of DE(E) for an initial period of 3 months, until 13/04/06. To accommodate no more than 25 Service Users To accommodate Service Users who are 65 years or over, who fall in the category OP - old age (not falling within any other category) 1/3/06 Date of last inspection Brief Description of the Service: Venn House is a Grade 2 listed house set in its own grounds on the edge of the village of Lamerton. The property consists of the main house that accommodates 16 people and a converted Coach House, a short distance away, that accommodates 9 people. The home is registered for people who are elderly and who fall into the category “OP”. The main house is of great character, with slate floors and gothic windows, however there are some steps between some rooms. The majority of rooms are en suite or have a bathroom close by. The Coach House Annexe is a short walk from the main house. It has it’s own lounge and dining room with a small kitchen for snacks and drinks. Like the main house there are bedrooms on the ground and first floor. Meals are brought over from the main house to the Coach house and eaten in the dining room. There are some bath adaptations in some bathrooms and there is a stair lift in the main and coach house. Venn House is not suited nor registered for people who have a significant level of disability. Many rooms look out over the gardens or surrounding countryside. The home is staffed 24 hours per day and has waking night staff. Venn House DS0000065984.V301931.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection involved three site visits to Venn House, 9.30am – 5.30pm on 2nd and 3rd August, and 7.15pm –11pm on the 15th August 06. Ten staff surveys were sent to the care home prior to the inspection, one was returned, A further six were distributed on 15th August 06, none were returned. The Inspector spoke with three staff by telephone who raised concerns, and five care staff during the visit to the home. The Inspector also spent time talking with the Manager. Ten Service user surveys were sent out, and nine were returned. In addition the Inspector spoke with 6 service users, and spent time with other service users over a meal. The Inspector also spoke with a District Nurse, an Occupational Therapist and a Physiotherapist regarding the Service at the home. This inspection included a tour of the buildings; time was spent looking at records including staff records, service user records and safety records. The fees for Venn House are £475 per week to £675 per week. Extra charges are made in relation to newspapers, hairdressing, toiletries, private chiropody, telephone, and dry cleaning. What the service does well: What has improved since the last inspection? A new call bell system was being fitted during this inspection, this will provide a more reliable system for Service Users to call for assistance. A new hot water system had also been installed. Bedrooms, as they have become vacant, have been redecorated. Venn House DS0000065984.V301931.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Venn House DS0000065984.V301931.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Venn House DS0000065984.V301931.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service Users cannot be confident that their care needs will be assessed and known prior to a move, which could mean that they will not be met. EVIDENCE: The records relating to one person who had recently moved to Venn House were looked at during the inspection on 2nd and 3rd August 06. No assessment of the individual’s needs had been made before the move, though one had been made subsequently. There was no evidence of confirmation to the individual that their needs could be met at Venn House. The process of assessing an individual before a move is to ensure that their needs are known so that their needs can be met from the beginning. At the visit made on 15th August 06 a further person had moved to Venn House. An assessment had been made of the individual’s needs prior to a move. This assessment had not been signed or dated. Venn House DS0000065984.V301931.R01.S.doc Version 5.2 Page 9 Intermediate care is not provided at Venn House; therefore this standard was not inspected. Venn House DS0000065984.V301931.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9, and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service Users cannot be assured that their needs will be consistently met, potentially placing them at risk. Many Service Users feel that they are treated with kindness and respect. The management and support offered to service users who self medicate could place service users at risk. EVIDENCE: The care needs of four Service Users were looked at in detail during the inspection on 2nd and 3rd August 06. Information about the nature of Service User needs and how staff should meet these needs should be contained in a Service User Plan. These documents had not been up dated or amended since the previous Registered Manager had left on 9th March 06, and were therefore out of date. For example where an individual needed more assistance to move around, there was evidence that there had been discussion with the relevant professionals, the family and the individual. However the Service User Plan and risk assessments had not been updated. Venn House DS0000065984.V301931.R01.S.doc Version 5.2 Page 11 A Service User Plan was seen on 15th August 06 relating to a person who had very recently moved to the home. The individual’s needs were different from those assessed, and therefore the Service User Plan was not accurate. There were notes in the daily record noting that the individual had different needs, but the Service User Plan had not been amended. One person’s plan indicated that the person had diabetes, and that their blood sugar levels when staff checked them should be between specific levels. However the actual blood sugar levels were consistently outside this “safe band”. The inspector was told that the medical professionals were aware of this and they were satisfied that it was safe. However there was no evidence of this or any amendments to the Service User Plan. The Inspector spoke with the District Nurse who visits Venn House and she had no concerns regarding the quality of care provided. Feedback included the fact that the District Nurses were called out when they were needed and that staff followed advice given. A new Service User Plan had been written for a Service User who had recently moved to Venn House. This document lacked detail- Service User Plans must contain information about how needs are to be met. For example it must specify not only that assistance is needed, but the nature of the assistance needed. One person used an incontinence aide- this was not noted in the Service User Plan, and there was no guidance or a protocol for staff to ensure that they used this aide properly. A further person had very low weight and there were issues around food and eating. Again there was a lack of information in the Plan. The person’s file indicated that their weight had only been recorded on one occasion. The Manager said she was aware of this issue and was working to address it, however the lack of written information means that each member of staff might approach the situation in a different manner. It also means that there is no clear record of weight change to pass on to relevant professionals. Clear and detailed Service User Plans should ensure that all care needs are met, and that a consistent approach is taken. The Inspector asked a new member of staff and the new manager whether they had read the Service User files. Neither individual had read all the Service User Plans, they said that this was due to insufficient time. The only staff survey information returned noted that had been provided. At the last inspection a requirement was made that any restrictive devices (such as door alarms) should only be used after consultation with the Service User, their representatives and any professionals involved in care. It was required that a record of this discussion and the circumstances the device is to be used is also to be recorded. This had been done for the situation referred to Venn House DS0000065984.V301931.R01.S.doc Version 5.2 Page 12 at the last inspection, however a further device had been introduced. It appeared that the use of pressure pad device had been discussed however these discussions were not recorded, nor was there any note of this in the Service User Plan. On the visit to Venn House on the evening of 15 August 06 staff raised the concern that the installation of the new call bell system had meant that the pendant alarms used by Service Users was no longer in use. Night Staff only became aware of this when they tried to provide these alarms for Service Users. Where the changes are made to the home, that impact on the care and well being of Service Users then they must be taken into account in the Service User Plan, and appropriate action taken. The Inspector was told that had a Service User had fallen and had got wedged behind a bathroom door, and no action had been taken to stop this happening again. Out of the ten Service User surveys returned five indicated that staff were always available when they were needed, whilst five stated that staff were usually or sometimes available. The Inspector spoke with Service Users about whether their needs were being met and many praised the staff for their kindness and consideration and described the care “very good”. However it is not sufficient that the standard of care provided to vulnerable people who may have complex needs should be solely reliant on the initiative of the care staff. The medication system was looked at during this inspection. Medication is kept in both the Coach House and the Main House. A Monitored Dose system, prepared by the pharmacist, is used. The system was generally well managed, apart from the occasional signature being missed when medication was administered. Of more serious concern was that one person had chosen to self-administer their medication. A risk assessment had been completed, however this was not signed and dated. No lockable box had been provided for this medication; in spite of the fact that it included a controlled drug. It was noted during this inspection that staff knocked on doors before entering rooms and people were addressed with respect by staff. The service user surveys showed that eight out of ten people felt that staff listened and acted up on what was said. Venn House DS0000065984.V301931.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service Users are helped and supported to exercise some choice and control over their lives. Service Users are provided with well-cooked meals that are generally to their taste and needs. EVIDENCE: Seven of the nine people completing a service user surveys said that there were “sometimes” activities in which they could participate. The manager said that they were trying to arrange more activities, a demonstration of flower arranging had recently been held. Most of the Service Users spoken with were of the view that they could get up and go to bed when they chose, and staff came to them when they rang for assistance. One person said that she thought that she had to be up in the morning by 8.00, although the manager said that this was not the case. One person surveyed commented that they had no choice about the clothes they wore. The manager was not aware of this, as she thought all staff were giving Service Users choice. It is recommended Service Users are consulted with Venn House DS0000065984.V301931.R01.S.doc Version 5.2 Page 14 regard to the help they need in their daily lives their wishes are recorded and taken into account. Service Users received visitors during the inspection and it was clear that this was the case at all other times. A post office shop visits the home each Thursday, so Service Users have the option of using this service. As has already been noted one issue raised at the last inspection was that alarm pads were in place to alert staff to attend a service user who might require assistance as they wandered out of their room in the night. Service User surveys showed that eight out of the nine people who responded always or usually liked the meals provided. Comments included “I’m a demivegetarian and my tastes are well catered for”, and “How does the kitchen continue to produce all the varied and meals and make them tasty?”. These views were supported by comments made directly to the Inspector, who also tried a meal and found it to be of a very high standard. One person was not happy with the food complaining that it was too stodgy. The cook confirmed that fresh high quality ingredients are used. Semi-skimmed and low fat yoghurts are used at Venn House, and whilst this may be appropriate for many of the Service Users, some individuals are underweight and this needs to be taken into account in their diet and choice of things like dairy products. The cook was aware of food preferences that individuals expressed, and the Inspector was told that alternatives were offered. It was of serious concern that refrigerators in the Main House and in the Coach House had failed seals, and were not maintaining an appropriate temperature for a year. This meant that Service Users health and well-being had been place at risk. An immediate requirement was made in relation to this issue. Venn House DS0000065984.V301931.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service Users cannot be confident in the complaints system currently operating. The system for recruiting staff is very poor and does not function to protect service users from potential abuse. EVIDENCE: Six out of the nine people who completed the survey said that they knew who to speak to if they were not happy about something. A record of complaints was available at Venn House, however nothing had been recorded in recent months, in spite of notes being made in the daily records that complaints had been made. A number of Service Users spoken with commented that they had not seen much of the new owners, and two service users voiced the opinion that there did not seem to be any one overseeing the home. One of the ways that a service can ensure that Service users are protected from abuse is by sound recruitment and staff support systems. The recruitment checks that should be in place were found not to have been taking place- see section on Staffing. There was no proper system of induction, so that staff were clear about what their role was, and the manager had little time to support or guide staff. Venn House DS0000065984.V301931.R01.S.doc Version 5.2 Page 16 A requirement was made at the last inspection that training in relation to adult protection be provided for staff. The manager said that she had training booked in relation to the Protection of Adults from abuse, in the near future. This was a requirement at the last inspection. Venn House DS0000065984.V301931.R01.S.doc Version 5.2 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24, 25 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Venn House is clean, comfortable and in good decorative order, however there are some areas where aspects of safety need improvement so that Service Users are not placed at risk. EVIDENCE: All of the building was seen during this inspection, with the exception of one bedroom, where a service user was unwell. Venn House is a grade 2 listed building and as such may not be as easily maintained as other buildings, however in spite of this the building appeared to well maintained. As bedrooms became empty they were being redecorated and refurbished. Some of the furniture in both lounges and in bedrooms is old and not entirely suited to people who have poor mobility- for example low seating. Work was being undertaken to replace the call bell system. One of the corridors on the ground floor was being revamped so that it had level access rather than a step. Venn House DS0000065984.V301931.R01.S.doc Version 5.2 Page 18 A new hot water system had recently been installed. The majority of the bathrooms had no thermometers to enable staff to check the temperature of hot water. One bathroom was found to have water over 50 degrees centigrade. There was a record of regular checks of hot water, completed by the handy person; it appeared that the excessively hot water might be due to the recent works. An immediate requirement was made in relation to regulating hot water temperature. Window locks were in place throughout the building however these were not in place in one bedroom. There was no risk assessment to analyse and mitigate the risk of falling from the windows. Venn House and the Coach House were clean, comfortable and homely. There were no offensive odours. Many of the bedrooms are large and Service Users have been able to bring in items of their own furniture. Only one of the bedrooms had a door lock. All bedrooms must have an appropriate door lock that allows the Service User to lock the door both from the inside and outside, but allows easy access in an emergency. As has already been noted no lockable spaces are provided in bedrooms, this is important not only for medication but for other items service users may wish to keep secure. The laundry has large washing and drying machines, space for washing to be dried. The floor is slate and the walls stone; the room was cluttered with items not in use. Access to the wash hand basin was blocked. In touring the building a number of shared bathrooms contained tablet soap, shampoo and hand towels, rather than liquid soap and disposable towels. This could potentially spread infections. One service user commented that other people used her toiletries. Service User’s toiletries should be individually identified or returned to their room. The control of infection system should be reviewed to ensure that out breaks of infection do not happen or are quickly contained. Venn House DS0000065984.V301931.R01.S.doc Version 5.2 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staff recruitment and induction procedures are poor and could place service users at risk. Staffing levels are of concern and may potentially place service users at risk. EVIDENCE: The Pre- inspection Questionnaire was not completed or returned before this inspection. This document provides the Inspector with a list of staff employed. The manager was unable to provide the Inspector with such a list. The Inspector therefore compared the first names of people on the rota with staff files. The files of recent employees were looked at during this inspection. Of the five staff files looked at, none had appropriate references taken prior to the individual starting work. Where there were references- these had not been taken from previous employers, but from people such as friends and family. CRB checks had been made however it was clear that in the time before they were received, staff worked unsupervised- this was confirmed by a member of staff. Basic information such as the date of the start of employment was missing. It was also noted that a file for one member of staff and a volunteer was missing. Proper pre-employment checks are part of the process of protecting service users. The omission of such checks places service users at risk. Venn House DS0000065984.V301931.R01.S.doc Version 5.2 Page 20 There was no record of any staff inductions, a new member of staff did confirm that there had been no formal induction, but that she had spent a couple of days shadowing other staff. Only one out of the ten staff surveys was returned. This survey indicates that this individual was not aware of some basic aspects of the work, and that there is no direction as to what care and support to provide to a new Service User. It was not possible to ascertain the level of training that had taken place in recent months from files or the number of staff who had an NVQ. Feedback from the District Nurse was that she was working with the manager to plan additional training in relation to such issues as pressure care. The current levels of staffing are three staff on during the day and at night, split between the two buildings depending on Service user needs. The previous Registered Manager was employed in addition to this level of staffing. The current manager is working over half her hours providing direct care. It is recognised that it is good practise for a manager as part of their management role to be familiar with the care provided by staff. However concerns raised throughout this report indicate there maybe insufficient management time. The manager confirmed that she had not read all of the Service user files. A total of four night staff raised concerns with the Inspector in relation to the plan to reduce the level of staffing in the evening and at night. The staff informed the inspector that there would only be one member of staff on duty from 7pm to 7am in the Main House with up to 16 Service Users and one staff on duty in the Coach House with up to 9 Service users. There would be an off site on call person to respond in emergencies. This reduction in staffing is of concern. One Service User spoke with the inspector on the 15th August 06 and expressed concern about the current higher level of staffing. The individual felt the need to prepare herself for bed, as the staff were occupied with another service user. This caused the individual considerable anxiety. It was also noted that one Service User provides considerable support to their spouse. This support enables staff to attend to other Service Users. Comments made by service users in surveys in relation to staffing include: “The house motto is “at the double””, “… it doesn’t leave the staff any time for the rest of us. I have to put myself to bed”, “Quite often my bed does not get made until late morning or even after lunch. Staff are willing but there seems to be a lack of direction”. Feedback from the District nurses was that there was no indication of a lack of staffing. The Inspector spoke to three members of staff by telephone who expressed concerns regarding planned changes to lower the levels of staff at night. The Registered Provider is required to ensure that there are sufficient staff by both Venn House DS0000065984.V301931.R01.S.doc Version 5.2 Page 21 day and night to meet the needs of service users, and that appropriate plans are in place to deal with any emergencies that occur. Venn House DS0000065984.V301931.R01.S.doc Version 5.2 Page 22 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The management of Venn House is inadequate and potentially places service user at risk. The management of health and safety is poor. EVIDENCE: There is no registered manager at Venn House, however there is a manager in post who confirmed that she would be applying to be registered in the near future. All services that are run by limited companies are required to ensure that a representative of the company completes monthly monitoring visits. Copies of the reports relating to these visits must be sent to the Commission. No such reports have been received from Venn Care Ltd. Venn House DS0000065984.V301931.R01.S.doc Version 5.2 Page 23 Mr Widders, the Responsible Individual, confirmed that there is no quality assurance system in place at present. One of the comments made by a Service user was that “It would be nice to discuss with someone how improvements could be made”. Cash is kept at Venn House on behalf of a number of Service users. The records relating to cash transaction was poor. There were no signatures, the balances recorded were incorrect, and there were no receipts. No fire risk assessment was available for inspection- thought there was information on file as to how to complete such a document. The Fire Log indicated that regular checks had been made in relation to much of the fire system, however the hold open devices on doors had not been checked. The Inspector discussed with the manager the fire procedure. These procedures were confusing and in need of review. There was evidence of regular checks on hot water, but no Legionella risk assessment. In spite of these checks one of the baths was found to have excessively hot water. An Environmental Health Officer had previously visited Venn House on 25th July 05 (when the home was under different ownership), and had noted that the refrigerator in the main house had a failed sealed and should be remedied within three weeks. Nothing appeared to have been done since that date. No record of fridge or freezer temperatures could be found in relation to the main house. There was a record of fridge temperatures for the Coach House. These indicated that the temperature had been above the acceptable level for a year, and was on one occasion recorded as 20 degrees centigrade. The seal on this fridge was also broken. It is of serious concern that food has been stored at an incorrect temperature potentially placing staff and service users at risk. It is also of serious concern that no manager or care staff recognised this, took appropriate action. Venn House DS0000065984.V301931.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 3 X X X X 2 2 2 STAFFING Standard No Score 27 1 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 1 X X 1 Venn House DS0000065984.V301931.R01.S.doc Version 5.2 Page 25 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 OP3 Regulation 14 Requirement Urgent Action: New service users must only be admitted following a comprehensive assessment of their needs, by a suitably qualified person. The Registered Provider must write to confirm to a prospective service user that they have the capacity to meet their needs, based on the assessment. This should be done prior to an admission. Restrictive devices, including pressure pads, must only be used after consultation with the Service Users, their representatives and any professionals involved in care. A record of this discussion and under what circumstances the device is to be used must be recorded. (This requirement was made at the 1/3/06 to be met by 1/6/06) 4 OP7 13 All Service Users must have access to a suitable call bell DS0000065984.V301931.R01.S.doc Timescale for action 06/09/06 2 OP3 14 02/10/06 3 OP7 15, 13 02/10/06 02/10/06 Venn House Version 5.2 Page 26 5 OP7 OP8 15 6 OP7 13, 15 7 OP9 13 8 OP9 13 9 OP16 22 10 OP18 18 system. All Service users must have a comprehensive Service User Plan that describes in detail the actions staff are to take to meet needs, including health care needs. These must be regularly reviewed to reflect changing needs. Urgent Action: The Registered Provider must ensure that all falls are monitored and appropriate action is taken to avoid a reoccurrence. Urgent Action: Service Users who self medicate must be provided with a lockable space for their medication. All medication administered must be signed. Where it not administered a reason must be provided. All complaints or concerns raised by Service Users must be recorded and appropriately investigated. All care staff should have training in relation to the protection of vulnerable adults. (This requirement was made at the inspection on 1/3/06 to be met by 1/8/06 and is outstanding). 02/10/06 06/09/06 06/09/06 02/10/06 02/10/06 02/10/06 11 OP26 16, 13 12 OP26 16, 13 13 OP27 18 The control of infection procedures must be reviewed, including ensuring that Service Users toiletries remain for their sole use. The laundry area must have washable floor and wall surfaces, and be suited to the management of soiled linen. Urgent Action: The Registered Provider must review the level of staffing to ensure sufficient is provided both during the day DS0000065984.V301931.R01.S.doc 02/10/06 01/01/07 06/09/06 Venn House Version 5.2 Page 27 14 OP29 19 15 OP29 19 and during the night to meet the needs of service users. The Registered Provider must ensure that there are appropriate plans are in place to deal with any emergencies that occur. Urgent Action: The Registered Provider must ensure that staff do not work without a Protection of Vulnerable Adult Check (POVA First), and do not work unsupervised until a satisfactory Criminal Records Bureau check has been received. Urgent Action: The Registered Provider must ensure that there is a robust recruitment process: including taking two written references prior to a person starting work in the home. (This requirement was made at the 1/3/06 to be met by 1/6/06) Urgent Action: All new staff should receive an induction and training to ensure that they are competent to fulfil their role. The Registered Provider must forward to the Commission and application for a Registered Manager for Venn House. The Registered Provider must arrange for unannounced monthly monitoring visits to establish the conduct of the home. Copies of reports made during these visits must be forwarded to the Commission. The Registered Provider must ensure that there is a quality assurance system, that takes into account the views of Service Users, is set up. The Registered Provider must ensure that money held on behalf of Service Users is properly accounted for. The Registered Provider must DS0000065984.V301931.R01.S.doc 06/09/06 06/09/06 16 OP30 19 06/09/06 17 OP31 8 02/10/06 18 OP31 26 01/10/06 19 OP33 24 01/12/06 20 OP35 17 01/10/06 21 OP38 13 01/11/06 Page 28 Venn House Version 5.2 22 OP15 OP38 13 23 OP38 OP25 13 24 OP38 13 ensure that risk assessments relating to individuals and to the environment are completed, and that appropriate checks are made to ensure that the premises remain safe. This must include risk assessments in relation to fire safety and Legionella. Checks must be made in relation to the functioning of the door hold open devices. Immediate requirement: The 03/08/06 Registered Provider is required to ensure that all food is stored at the appropriate temperature. Immediate requirement: Hot 03/08/06 water in baths and showers must be regulated to ensure that it is no hotter than 43 degrees centigrade. The Fire Procedure must be 02/10/06 reviewed to ensure that the actions staff are to take are clear. 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 Refer to Standard OP12 OP15 Good Practice Recommendations Ensure that SU preferences taken into account in all aspects of daily life, including time to get up and go to bed. The food provided, including dairy products, should reflect the dietary needs of Service Users. Venn House DS0000065984.V301931.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 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 Venn House DS0000065984.V301931.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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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