Inspection on 12/02/09 for Victoria Care Home

This inspection was carried out on 12th February 2009.

CSCI found this care home to be providing an Poor service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 19 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Victoria Care Home 19/11/07

Victoria Care Home 11/07/06

Victoria Care Home 02/11/05

Victoria Care Home 23/06/05

Victoria Care Home 11/01/05

Victoria Care Home 20/07/04

Victoria Care Home 02/03/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Victoria Care Home Memorial Avenue Worksop Nottinghamshire S80 2BJ     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Lynda Dyer     Date: 1 2 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 35 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 35 Information about the care home Name of care home: Address: Victoria Care Home Memorial Avenue Worksop Nottinghamshire S80 2BJ 01909476416 01909476089 victoriacarehome@yahoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Dukeries Health Care Limited care home 93 Number of places (if applicable): Under 65 Over 65 0 93 dementia old age, not falling within any other category Additional conditions: 93 0 The maximum number of service users who can be accommodated is: 93 The registered person may provide the following category of service only: Care home only - Care PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling in any other category - Code OP Dementia - Code DE Date of last inspection Brief description of the care home Victoria Care Home is a care home providing personal care and accommodation for 93 older people. The current registration categories are older people, dementia and people with dementia bought about through alcohol related brain injury (Korsakoffs syndrome). There are three units accommodating residents over 65 years old (Lancelot for people with dementia, Guinevere and Camelot for old age not falling within any other category) and one unit for people with Korsakoffs syndrome (Champion Crescent). The home provides short and long term care and will accept emergency admissions. A respite service is available if required. The home is owned by Dukeries Health Care, which is run as a small business. The home is located in a residential area Care Homes for Older People Page 4 of 35 Brief description of the care home of Worksop close to shops, pubs, the post office, library and a church. There is also a park opposite. The home was opened in 1996 and was purpose built. The home is split in to four separate units. All of the homes bedrooms are single and have en-suite facilities. Bedrooms are located on 2 floors and there is a passenger lift. The home has 2 gardens that are easily accessible, one of which is enclosed. There is ample car parking available. The acting manager told us on the day of the inspection that the fees range between £353 and £850 depending on needs. There are additional charges for hairdressing and chiropody. Care Homes for Older People Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The focus of inspections undertaken by the Commission for Social Care Inspection is upon outcomes for people who live at the home and their views on the service provided. This process considers the providers capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. We have introduced a new way of working with owners and acting managers. We ask them to fill in a questionnaire about how well their service provides for the needs of the people who live there and how they can and intend to improve their service, this is called an Annual quality assurance assessment ( AQAA). Care Homes for Older People Page 6 of 35 We received the AQAA back from the acting manager in good time and the main body of the form was well completed. However, the section where we ask about staffing numbers and qualifications was not completed. On the day of the inspection the acting manager said this was an oversight. The part of the AQAA that was completed helped us to plan our inspection. We also sent out 60 surveys called, have your say, to people who live in the home, staff that work there and visitors. This meant we could get an idea of what people thought about the way the service was run. We did not have any of these returned to us and on the day of the inspection the acting manager stated that the surveys had been distributed to people but none had been completed and returned. We reviewed all of the information we have received about the service since we last visited and we considered this in planning the visit and deciding what areas to look at. The date of the last key inspection carried out by the Commission was November 19th 2007. The main method of inspection we use is called case tracking, which involved us choosing three people who live at the service and looking at the quality of the care they receive by speaking to them, observation, reading their records and asking staff about their needs. Due to the size of the service, which is spread over four units this inspection was completed by two inspectors over a period of 7 hours on February 12th 2009. We concentrated the case tracking in one unit but we also had a pharmacy inspector with us who inspected the medication procedures of all four units. Because people with dementia are not always able to tell us about their experiences, we have used a formal way to observe people in this inspection to help us understand. We call this the Short Observational Framework for Inspection (SOFI). This involved us observing a small number of people who live in the home for 2 hours and recording their experiences at regular intervals. This included their state of well being, and how staff interacted with them. We also observed how the people living in the home interacted with other people living there and with the environment. The observation took place in the dining room and lounge in the Lancelot unit of the home. We spoke with three members of staff and six people who live in the home to form an opinion about the quality of the service being provided to people living at the home. We did not see any visitors to speak with. The acting manager and the deputy acting manager assisted us by providing records that we needed to see on the day of the inspection. We read documents as part of this visit and medication was inspected to form an opinion about the health and safety of people who live at the service. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 35 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People that are admitted to the home have their needs assessed prior to admission which means staff are able to plan for their individual needs and will know how to care for them. Evidence: The home has formal documentation in place for carrying out holistic needs assessment. We looked at the most recent emergency admission to the home. There was a full needs assessment in place for this person, which gave all the information that staff would need to deliver the care required. The deputy manager told us that a care plan was also in the process of being produced for this person. This means that staff have the information they need to deliver the appropriate care to people being admitted to the home. Care Homes for Older People Page 10 of 35 Evidence: We examined the care plans of three people living in the home and they all contained a pre-admission assessment and the acting manager told us that the home ensures prospective service users have a well planned admission wherever possible. The home does not offer intermediate care so this standard does not apply. Care Homes for Older People Page 11 of 35 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Risks around peoples health care are not being managed, peoples privacy and dignity are not always respected and medication procedures are not safe. Evidence: The person most recently admitted to the home had been admitted the evening prior to the inspection and they did not have any basic items to enable them to maintain their personal hygiene. The recording of people receiving baths is done in three different places and is not clear. This means the home cannot clearly show if people are receiving the help with personal hygiene that they need. Where people have been assessed as having risks around nutrition, there was no evidence to show how these risks were being addressed such as regular weighing and nutritional screening. Care Homes for Older People Page 12 of 35 Evidence: We saw letters to families inviting them in to discuss care planning and evidence that staff recorded when they spoke with families. However it was not clear if people were agreeing to their plans of care either by signing them or any other evidence. Risk assessments surrounding pressure areas and falls have been implemented to care plans but where risks have been identified, a plan of how staff should manage this risk has not been recorded. Some information in the care plans is not being updated to show the persons current care needs. This means that people with identified risks may not be receiving the health care support they need to manage the risk. The home operates a policy of knocking before entering a persons room to ensure privacy, dignity and respect and this practice was observed on the day of the inspection. Staff spoken with had knowledge of procedures they needed to follow to respect peoples privacy and dignity when assisting them with personal care. We observed one person living in the home who was sitting in the lounge and their clothing had ridden up to expose their thighs. Staff coming into the lounge made no attempt to adjust the clothing. Where we identified that medication errors had occurred, there were no records available for us to see what action had been taken to address this and we had not been notified of the errors. We looked at the homes medicine management practices by examination of all four medicine units. This involved the sample audit of the medicines, Medicine Administration Records (MAR) charts, Monitored Dosage System (MDS) and storage facilities. We also observed a small part of two lunch-time medicine rounds in the home. Medication records are generally up to date for each person in service. The medicines received, administered and disposed of are generally recorded. However there were several gaps in recording where staff had not signed that medication was administered or not administered (including external preparations and nutritional drinks) without any explanation or reasons. This potentially could compromise the Health and Welfare of people living in the service if medication had not been supplied. We found during lunch time care staff on two separate medication rounds would sign the MAR chart before administration. This practice and lack of proper procedure puts people who use the service at risk. We observed medicines were sometimes administered with dignity and a drink provided. However we also observed staff loudly voicing across the room whether an Care Homes for Older People Page 13 of 35 Evidence: indigestion remedy and a pain killer was required when other people were in the dining room. During inspection we conducted a sample audit of medicines available for administration. However the quantity of medicines remaining and the number of signatures on the MAR chart did not correlate. The quantity of all medicines received were recorded, however any balances carried over from previous cycles were not recorded or dated when this was carried forward. This made the audit difficult. A MAR chart indicated under allergies, none known. However the care plan of a person living in the service contained a record that stated they had an allergy to a series of medications (Aspirin, Brufen, Voltarol and Feldene). The controlled drug balances were correct and these reflected accurately in both the CD register and MAR chart. However The CD register was not pre-numbered and this made the audit difficult. The page numbers were not always written which would cause difficulty for staff to find the correct page to record medicines. We found dispensing labels on two bottles of Temazepam Liquid to be un-readable due to the medicine being poured over the labels. Staff were unable to inform us to which bottle belongs to which person living in the service. One of the Controlled Drug cabinets was in an unclean state. A bottle of Temazepam Liquid dispensed in December 2008 and labelled do not use after Jan 2009 was found and not appropriately discarded. During Inspection we observed excess stocks and expired unwanted medicines were found in the units. One Drug trolley was found with loose tablets, two blister foils containing tablets and sachets without pharmacy labelled cartons. We observed that there were several unsecured storage boxes of medicines for disposal in some of the units. We found care staff personal belongings left in the medicine units. We observed that some medicine cabinets stored cigarettes, jewellery, money, stationary and other home or care staff personal belongings. We observed an unauthorised member of staff obtaining keys to fetch some cigarettes stored in the medicine cupboards. Two of the units were disorganised, and untidy. Some of the drug trolleys were not securely linked to the wall. During Inspection we observed that a chiropody clinic was being held in one of the Care Homes for Older People Page 14 of 35 Evidence: high dependency units. We found people living in the service coming into this unit for treatment. Medicines were found on the worktop (insulin, insulin needles, external creams and diagnostic strips) in the unit. A Fridge was found unlocked and we were informed that a key to lock the fridge was unavailable. This Fridge was also in an unclean and untidy state. Fridges contained several medicines including eye drops, insulin and a nutritional drink with no date of opening, unlabelled or without a carton to indicate the name of the person living in the service. Some medicines were stored incorrectly in the fridge and not in accordance with their product licenses. Daily records of fridge temperature and external unit temperature were made. However there were gaps in both recordings and sometimes temperatures readings were beyond the correct range. Nothing on the record sheets states what to do in the event of fridge or external temperatures reading beyond the specified range. We were informed that all carers handling medicines had medication training. A list was provided of when training was undertaken and their certificates were made available. Whilst the home has recently put a system in place to ensure medication administration competency including auditing of drug administration and storage, we found discrepancies in compliance. We observed that a comprehensive medication policy was available however some staff members had not always followed their medicine policies and best practice. There is a lack of awareness and some staff are unclear of what is required which could potentially compromise the health and welfare of people living in the home. Care Homes for Older People Page 15 of 35 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People that live in the home have their individual preferences represented in the activities. However, some people with dementia are not being fully supported in their daily wellbeing. Evidence: We spoke to people living in the home and they told us that they are supported to get up and go to bed when they liked and that they were able to have visitors and see them in private if they wished. The home employs full time activity coordinators who work with groups and individuals living in the home during the week. They do a variety of activities and we saw people enjoying a game of dominoes in the morning and bingo in the afternoon. We spoke with one of the activity organisers and they showed a good awareness of peoples needs and said that they spend time talking or sitting with people who live in the home. They verbally demonstrated that they try to see each individual person every day and Care Homes for Older People Page 16 of 35 Evidence: records of this were seen. They record peoples preferences and told us that they try to arrange activities to suit each person. There is also an activities timetable that is displayed in large format in the home. This means that people living in the home are offered the choice of stimulating activities. One person we spoke to said that they didnt always like to take part in the activities but told us I really like the singer. Religious needs are met through the local community either by the service users attending a place of worship, or the local clergy coming into the home. The short observational framework for inspection, carried out by observing people with dementia, showed staff speaking kindly with people living there, which made it appear that generally peoples wellbeing was being supported. However one person living in the home was either asleep or in a withdrawn state throughout the assessment and their wellbeing was not being supported. The television was on very loud but staff did not ask if people wanted the television on or attempt to spend time with the people in this area. This means that carers may not always be supporting the wellbeing of people in the dementia unit. We saw meals being served in the home and they looked appetising and nutritious. People we spoke to told us that they were offered a choice at mealtimes and that the food was good. The home offers three meals each day, together with snacks and drinks. The environmental health officer had inspected the kitchens in 2008 and at the time of the inspection standards were found to be good and no recommendations were made. Care Homes for Older People Page 17 of 35 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The lack of up to date policies for responding to any allegation of abuse means staff may not know how to respond appropriately to safeguard people living in the home. Evidence: The service has received 14 complaints since the last inspection. We looked at the complaints records in the home and although it appeared that complaints were being addressed and actioned by the acting manager, this was difficult to audit as the records were disorganised. The commission has received 7 complaints about the service since the last inspection. These have been referred to the manager to deal with, using the homes complaints procedures, and have been dealt with appropriately. The complaints procedure was on display but the details of how to contact the commission are out of date. People living in the home and staff spoken with confirmed they knew how to make a complaint. The home does not have the current local procedures for dealing with and referring Care Homes for Older People Page 18 of 35 Evidence: safeguarding incidents. This means people may not be safeguarded from the risk of abuse as there is no clear and specific guidance for staff to know when incidents need external input and who to refer the incident to. Care Homes for Older People Page 19 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Ongoing maintenance and housekeeping procedures generally provide people with clean and homely surroundings in which to live. However some reorganisation could make the environment more pleasant and safe. Evidence: The acting manager told us that the home has introduced a relaxing nursery type environment to the unit which cares for people with dementia. However on the day of the inspection, this area was not very clean, was cluttered and did not look as if it was being used for the purpose it was intended. The rest of the home appeared to be fresh, clean, warm and well maintained. The lounge areas and bedrooms we viewed were clean, fresh, pleasant and personalised. The acting manager told us that people were now being offered a key to their bedroom and if it was refused or deemed inappropriate then a risk assessment was placed in the care plan. We saw evidence of this and one person we spoke to said they used to have a key but didnt now as they didnt need it. The home will accommodate as much as possible of a service users personal possessions which they wish to bring with them into the home. Care Homes for Older People Page 20 of 35 Evidence: The home has a nurse call system with an alarm facility in every room. However in two rooms that we viewed, the alarm point was some distance away from the people sitting in the room and was not accessible. This means people may not be able to summon care staff if they require assistance. The last key inspection identified that there were a number of smokers in the home and that the home was a non smoking home and recommended that a shelter was provided for people to smoke outside. We discussed this with the acting manager as this issue had not been resolved and he told us that the company did not feel it was prudent to have a smoking shelter but that people living in the home could smoke outside the front entrance where there is an overhead shelter. He told us that there were plans for the Champion unit to have a lean to, for people to smoke in but not for the older persons units. The home has outdoor space which is accessible to all service users including those with mobility problems. However there was a high number of discarded cigarette ends in the rear garden, outside the Lancelot unit. The laundry had the necessary sorting area and sluicing facilities and staff had a good understanding of infection control procedures and policies were in place. This means that the care home is maintained appropriately to reduce the risk of infection and cross infection. The shared areas provide a choice of communal space with opportunities to meet relatives and friends in private. Care Homes for Older People Page 21 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improved recruitment procedures and staffing levels in the home ensure that people living in the home should be, as far as reasonably possible, protected from risk. Evidence: The home has reviewed its staffing levels and has been recruiting more care staff over the last few months. Staff we spoke with said that there were generally enough staff on duty to meet the needs of people living in the home. People living in the home told us that there were enough staff on duty and that if they wanted assistance it was given. One person told us, I am very happy in the home and the staff are helpful. Observations of staff interacting with people living in the home was generally good with staff sometimes respecting peoples privacy and dignity. The home has an online training matrix and staff have certificates for training in their files for areas of health and safety and care delivery. Care Homes for Older People Page 22 of 35 Evidence: Staff spoken with demonstrated that they have a good understanding of the needs of service users to deliver personal care. The arrangements in place to train staff were seen and show that the acting manager recognises the importance of having a well trained staff team and plans for their training to make sure they are kept up to date with current good practice. The files did not contain any evidence of a formal induction, although the acting manager said that the e-learning programmer covered the induction process. We viewed three files of people working in the home and they held some of the necessary documentation although there were some gaps and the files were disorganised. There was evidence that some staff had commenced working in the home before a satisfactory criminal disclosure had been obtained for them, however this practice was before the new acting manager took up his post, and we are satisfied that this practice is no longer occurring. The acting manager told us that the core of the staff team have worked in the home for many years and are a stable team. All staff are clear regarding their role and what is expected of them and people living in the home report that staff working with them know what they are meant to do, and that they meet their individual needs in a way that they are satisfied with. Care Homes for Older People Page 23 of 35 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although there is evidence that the home is run in the best interests of the people that live there, systems for managing peoples finances show their financial interests are not fully safeguarded. Evidence: Some of the homes contracts for maintenance by external contractors are up to date and the maintenance schedule followed. Fire systems are safe and generally well organised, although it was noted that there were several omissions of recording the weekly testing of the system during the last few months. We received the Annual Quality Assurance Assessment back from the acting manager in good time, the main body of the form was well completed although the section were we ask about staffing numbers and qualifications was not completed. On the day of the Care Homes for Older People Page 24 of 35 Evidence: inspection the acting manager said this was an oversight. The acting manager has worked at the home for 4 months. He has 10 years experience in care management. He has not yet been registered with the commission for social care inspection. Staff we spoke to said that the acting manager was approachable and provided support for staff. Audits on the home are regularly undertaken by the head of clinical governance for Dukeries Health care. We saw the records of these audits, however the shortfalls we identified in record keeping had not been identified during these audits. The home will help people who live there assistance to manage their personal allowances, if they require or request it. The administrator is responsible for the safekeeping of peoples personal spending money and also for the management of the bank account held for this purpose. We examined the statements of this bank account and We spoke with the administrator, who stated that the bank account where peoples personal spending money was held was a pooled account and that they kept a record of how much money each person had in this account. Records were difficult to understand with residents money not being accounted for in a clear and transparent way. We were not able to view the receipts from the hairdresser or the receipts of valuables kept in the home but the acting manager told us that these were being maintained. Twice during the inspection we were able to access the home without having to summon a member of staff. The door we accessed leads into a communal area, which is used by people who live in the home. This means that people living in the home are not being protected from people entering the building and people living in that unit who have cogitative issues are not being safeguarded from leaving the home unsupervised. A quality assurance survey has been carried out with people who live in the home and with visitors since the last inspection and the results have been produced along with an action plan of what the acting manager intended to do to address any issues. The surveys were very thorough and the results were well detailed and included all comments received about the service. The acting manager told us that the home now has three hoists and two stand aids, as Care Homes for Older People Page 25 of 35 Evidence: well as other lifting aids and that staff are trained in moving and handling. The files of the staff that we examined had current moving and handling certificates in place. The acting manager is improving and developing systems that monitor practice and compliance with the plans, policies and procedures of the home. However, more work is needed in this area. The insurance certificate in respect of death, injury, public liability, damage or other loss is on display but ran out of date in January this year. Care Homes for Older People Page 26 of 35 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 15 The registered person must ensure that care plans include all relevant and current information and are signed. Partly met. Timescale extended in consideration of change in manager and introduction of new care plans. This will ensure that the individual service users needs are fully met. 19/01/2008 2 9 132 Staff must ensure that they 29/12/2007 do not sign the medication record until visibly observing the service user has taken the medication. Care Homes for Older People Page 27 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 17 Where a risk is identified in a persons care plan, surrounding pressure areas, falls and other specialist needs, a plan of how staff should manage this risk must be recorded. This will ensure people get the care that they need. 30/04/2009 2 7 15 Care plans must be reviewed 23/09/2009 at least monthly in consultation with the service user and representative if appropriate. This will ensure people have their care delivered the way they wish. 3 8 17 Nutritional screening must be undertaken on admission and on a periodic basis, a record maintained and appropriate action taken when changes risks are identified. 22/06/2009 Care Homes for Older People Page 28 of 35 This will ensure peoples nutritional needs are met. 4 9 13 Appropriate stock levels of 15/04/2009 medication must be maintained and reference must be made to the GP to adjust quantities accordingly before ordering new prescriptions. This to reduce the risk of mal-administration and theft. 5 9 12 Any unwanted Controlled Drugs and medicines must be securely stored and properly disposed of. This to reduce the risk of mal-administration and theft. 6 9 13 Only medicines must be securely stored in the designated medicine cupboards. Access to medicine keys must be made only available to designated trained staff. This to reduce the risk of mal-administration and theft. 7 9 13 A Controlled Drugs register, with numbered pages, must be provided for the secure recording of any Controlled Drugs. In order to ensure that staff follow through running balances to the corresponding pages. 15/04/2009 15/04/2009 15/04/2009 Care Homes for Older People Page 29 of 35 8 9 13 Medicines, including external 15/04/2009 preparations and nutritional drinks must be given to people as prescribed at all times. This must be demonstrated by the homes record keeping practices. To safeguard the health and Welfare of people living in the home. 9 9 13 The quantity of all medicines 15/04/2009 received and any balances carried over from previous cycles must be recorded and dated. To enable audits to take place to demonstrate the medicines are administered as prescribed. Medication Administration Record (MAR) charts must be signed immediately after the medication has been administered, not before or at a later time. To safeguard the health and Welfare of people living in the home. 15/04/2009 10 9 13 11 9 13 The medicine policies, Training and assessment in medication administration competency including auditing of drug administration and storage must be reviewed to enhance its accuracy. The medication polices must be reviewed and reflect good practice. Staff must be trained to adhere to them. 15/04/2009 Care Homes for Older People Page 30 of 35 Appropriate action must be taken when medicines are not correctly recorded, not administered as prescribed and records do not reflect practice. The medicines policy must be updated and signed with a two year review date. This is to ensure that all medicines are administered as prescribed and this can be demonstrated. 12 9 37 The registered person must inform the commission, without delay, of any event in the care home which adversely affects the wellbeing or safety of any service user. This must include any medication errors that are made in the home. This means we are kept informed of incidents that may affect the well-being of people living in the home. 13 18 13 13 (6) The manager must implement policies and procedures that meet current local safeguarding referring procedures. This will promote the safety and protection of people living in the home. 14 18 13 Senior care staff must be trained in the current local safeguarding referral procedures. 07/09/2009 13/04/2009 13/04/2009 Care Homes for Older People Page 31 of 35 This will promote the safety and protection of people living in the home. 15 29 19 Where a person has previously worked with vulnerable people, verification of the reason why the employment ended must be recorded in staff files. This will protect people from potential harm. 16 29 19 A full employment history, together with a satisfactory written explanation of any gaps in employment must be recorded in the staff members file. This means that people living in the home will be protected. 17 29 19 The registered person shall 19/05/2009 not employ a person to work at the home until a satisfactory criminal records disclosure has been received. This means that people living in the home will be protected. 18 35 20 Money belonging to a 20/07/2009 service user must not be paid into a bank account unless the bank account is in the name of the service user or service users to which the money belongs. This will mean that peoples 19/05/2009 13/04/2009 Care Homes for Older People Page 32 of 35 money can be accounted for in a clear and transparent way and will not be used for any other purpose. 19 38 13 13 (c) The manager must identify the risks associated with the main entrance to the home not being secure at all times and address those risks. This will protect people from possible harm. 08/06/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 8 The records of people receiving baths should be in one place and a clear audit trail in place. This will ensure sure that people refusing baths are monitored for reasons why they may be refusing. Individual bedrooms should be risk assessed with regard to call bell positioning. This will ensure people that need to summon help are able to do so from where they are sitting/sleeping. The policies and procedures relating to the handling of medication should be reviewed and updated in line with the guidance from the Royal Pharmaceutical Society document, The Handling of medicines in Social Care settings published 2007. Action to be taken for staff to follow fridge manufacturers specifications to reset as soon as daily temperature readings have been recorded. Staff to take action in the event of medicines stored outside the temperature range. Medicines must be stored under appropriate environmental conditions in compliance with their product licence to maintain their stability. This will ensure the quality of medicines in use and protect residents from harm. The home is to action that any known allergies are recorded on the MAR chart or nil known where Page 33 of 35 2 8 3 9 4 9 5 9 6 9 Care Homes for Older People appropriate. 7 9 The home should liaise with the supplying pharmacist to update the allergies of people living in the home. This information needs to be completed to ensure staff are aware to report and record any occurrence of side effects ensuring medicines are given appropriately. Ensure staff working with people in the unit providing care for people with dementia are trained in supporting the wellbeing of their choices in daily living. The complaints procedure must include the correct details of how to contact the commission. Review the complaints file and ensure there is a clear audit trail with the complaints being in date order with the investigation notes and outcome kept with the initial complaint. Address the situation raised about smoking service users and if service users are expected to go outside to smoke, then a suitable weather shelter be provided. Provide suitable facilities for people to dispose of cigarette butts in the rear garden area outside Lancelot. De-clutter the nursery area and ensure it is included in the cleaning schedule of the home. A formal induction process should be introduced for new staff with certification given at the end of the induction period which will assess the member of staff now competent to work unsupervised in the home. The staff personnel files should be reviewed and organised in a way that will allow important information to be found more easily. The heating system and gas appliances should be services annually by an approved contractor. Audits should be implemented with regard to the weekly fire tests to ensure they are being carried out. 8 12 9 10 16 16 11 19 12 13 14 19 19 28 15 29 16 17 38 38 Care Homes for Older People Page 34 of 35 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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