Inspection on 11/12/07 for Victoria Cottage Residential Home

This inspection was carried out on 11th December 2007.

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

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

Other inspections for this house

Victoria Cottage Residential Home 28/04/09

Victoria Cottage Residential Home 30/05/08

Victoria Cottage Residential Home 14/05/07

Victoria Cottage Residential Home 15/12/06

Victoria Cottage Residential Home 09/02/06

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Victoria Cottage Residential home 13 Station Road Lowdham Nottingham NG14 7DU Lead Inspector Jayne Hilton Unannounced Inspection 11th December 2007 07:30 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 Victoria Cottage Residential home DS0000063057.V355337.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. Victoria Cottage Residential home DS0000063057.V355337.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Victoria Cottage Residential home Address 13 Station Road Lowdham Nottingham NG14 7DU 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) 0115 966 3375 Sun Care Homes Ltd Andrea Josephine Clark Care Home 18 Category(ies) of Old age, not falling within any other category registration, with number (18) of places Victoria Cottage Residential home DS0000063057.V355337.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th May 2007 Brief Description of the Service: Victoria Cottage is a care home providing personal care and accommodation for 18 older people. The home is owned by, Mr Pancholi. The home is located in the village of Lowdham, close to shops, pubs and other local amenities. The home was opened in 1984 and consists of a converted 2 storey house with a newer purpose built extension. All the home’s bedrooms are single and 9 of the bedrooms have en-suite facilities. There is a passenger lift. The home has small gardens. Fees range between £289-£360 a week. This information was provided by, the manager on 11/12/2007. Service users are expected to pay for hairdressing, Chiropody and newspapers in addition to this. The Statement of Purpose and Service User Guide are available in the home and service users have a copy in their bedroom. An inspection report was also available in the home and information was provided to service users their relatives/visitors of how they can access a copy of the previous inspection report on the home. Victoria Cottage Residential home DS0000063057.V355337.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection is upon outcomes for service users and their views on the service provided. This process considers the provider’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. This inspection took place over 7.5 daytime hours and was unannounced. The main method of inspection used was called ‘case tracking.’ This involves selecting three service users and looking at the quality of the care they receive by talking to them, examining their care files and discussing how support is offered to them by staff members. Not all service users who were “case tracked” were able to help by giving an opinion about the care provided, as one person was ill in bed. Three members of staff, two service users and the manager were spoken with as part of this inspection, documents were read and medication inspected to form an opinion about the quality of the care provided to service users. Prior to completing this visit the inspector assessed the homes service history including complaints and safeguarding referrals. The Annual Quality Assurance Assessment completed by the manager was also used in assessing evidence of the quality of service. Two Random Inspections have been undertaken [by a Pharmacist Inspector] on 11/6/07 and 9/10/07 since the last Key inspection, because of concerns about medication management in the home. What the service does well: Service users have some information they need about the home and their needs are assessed prior to moving into the home The home has Equality and Diversity policy in place and training is provided for staff in the topic. Victoria Cottage Residential home DS0000063057.V355337.R01.S.doc Version 5.2 Page 6 Service users live in a home, which is managed by a Registered Manager, who runs the home in the best interests of service users and the number of staff provided meets service users needs. Service users live in a comfortable and clean environment. Service users are confident that their complaints will be listened to, taken seriously and acted upon. Service users are protected from abuse. Service users generally find the lifestyle experienced in the home matches their expectations. Service users are helped to exercise choice and control over their lives. Service users confirmed that staff always respects privacy and dignity. Staff spoken with confirmed that they knew how to treat service users with respect at all times and described how privacy was promoted. Observations made of interaction between staff and service users on the day of the inspection supported this also. Interaction between service users and staff was on the whole calm and positive. Service users said they enjoyed the food. A service user praised the home admission process. Another service users said, “You get well looked after here” Service users spoken with confirmed that the care provided was of a good standard in their opinion. What has improved since the last inspection? Recruitment Practices are now satisfactory. The outdoor space for service users, which was previously paved has been levelled and made safe. Victoria Cottage Residential home DS0000063057.V355337.R01.S.doc Version 5.2 Page 7 A gas fire in the lounge was protected by a fireguard, which is now fully secured. Although additional handrails have been fitted in the toilet and bathrooms. Some areas of medication management have been improved upon and there is now appropriate storage for controlled drugs. Supervision records are in place. What they could do better: An up to date Statement of Purpose could be available at the home when requested, so that people have the information they need about the home. The assessment of service users needs could be kept under review and revised where service users needs change. Particularly in respect of nutritional needs, Blood Glucose monitoring and bowel healthcare. This will help staff understand the needs of service users and help them give people the care they need. Care plans could be developed to include support plans for all healthcare needs and the medicines relating to them. This will help staff understand the needs of service users and help them give people the care they need. Person Centred Planning formats could be introduced for all service users to ensure that staff give people the care they need. The arrangements for managing the medication for service users must be made safer to make sure that unnecessary risks are avoided and people get their medication as prescribed by their Doctor. The daily menu could be displayed in the home so that service users know what is available and can make informed choices at meal times. ‘SHARPS’ items such as disposable razors should be appropriately stored and disposed of after use to ensure service users are not placed at risk of harm. The manager could develop the agenda of equality and diversity in the home so that staff are aware of any gender, sexuality, race and cultural needs of individuals and how these will be met. Victoria Cottage Residential home DS0000063057.V355337.R01.S.doc Version 5.2 Page 8 Service users and /or their representative’s could be involved in their care they receive so that they give their views on how they want to be helped and sign their agreement to the assessment or care plan. Progress notes could be more detailed to fully address and reflect the holistic needs of service users and their daily routines and choices made. A professional assessment of the aids and adaptations within the home could be obtained to ensure that the equipment provided is safe for and meets the needs of the current service users. Staff could be provided with appropriate storage for their personal toiletries, so these are not left accessible to service users and which may place service users at risk. Training for staff could be provided in care planning, food and nutrition and refresher training in diabetes, which will help them understand the needs of service users and support people in abetter way. The supervision and appraisal of staff could be better and their work practice could be assessed and monitored in depth to make sure they are supporting service users properly. Eight requirements have been made, three of which require immediate action. Twelve good practice recommendations have also been made. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Victoria Cottage Residential home DS0000063057.V355337.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Victoria Cottage Residential home DS0000063057.V355337.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users have some information they need about the home, but further development of the assessment and care plan documentation is needed to ensure service users needs, will be fully met. The home does not currently provide an intermediate care service EVIDENCE: The combined Statement of Purpose/Service User Guide and copies of previous inspection reports are available in the home, but the version given to us by the manager to view was not an up to date copy. Although there is a section about fees, these, were not detailed in the service user guide. This means that people do not have all of the information they need about the home. Victoria Cottage Residential home DS0000063057.V355337.R01.S.doc Version 5.2 Page 11 Service users needs are assessed prior to moving into the home and Social Workers assessments were seen where appropriate. The assessment documentation was appropriate but further development of the document in respect of the identification of diversity needs is recommended. Service users spoken with confirmed that the care provided was of a good standard in their opinion. It is recommended that ‘Person Centred Planning’ formats be introduced for all service users to ensure their needs and wishes are being fully met. The home has Equality and Diversity policy in place and training is provided for staff in the topic and service users are supported with their religious needs. However further development of the diversity needs of service users within the assessment and care plan process should be explored to ensure information about any gender, disability, sexuality, race and cultural needs of individuals needs of service users and how these will be met Also service users and /or their representatives had not signed their involvement or agreement to the assessment or care plan. A service user praised the home admission process, stating that staff had spent extra time, offering reassurance and listening to their needs and that they had settled in very well. Another service users said, “You get well looked after here” Victoria Cottage Residential home DS0000063057.V355337.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 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 heath and personal care needs are not being fully met and they are not protected by the homes policies and procedures for dealing with medicines. EVIDENCE: Care plans and associated risk assessments, although basic, were in place for the three service users personal files examined, which generally informed staff of how the service users individual needs were to be met, however there were no care plans in place for the people case tracked that included support plans for all of their healthcare needs and the medicines relating to them. This would help staff understand the needs of service users and help them give people the care they need. Victoria Cottage Residential home DS0000063057.V355337.R01.S.doc Version 5.2 Page 13 Care plans were in place for diabetes. One person’s Blood Glucose reading was recorded as high [27.3] on 9th Dec 2007 but no action had been taken in respect of this and there was no further record that a check had been taken on the 10th December 2007. There was evidence of regular review but where service users needs had changed for example where significant weight loss had occurred, or they had seen the GP for constipation this had not been considered in the review documentation, neither had a new care plan been implemented. There had been some improvements noted to the care planning system, so the timescale for the requirement set at the previous inspection has been extended. Progress notes are completed daily but contained only basic information for example “has been fine today”, “went to day centre” “ate all of lunch” ‘Feeding assessments’ were used for nutritional screening of service users needs, however where a service user’s nutritional needs had changed the assessment had not been reviewed and updated. Staff reported that they monitor the bowel movements of service users, but there were no records in place in the care plans to evidence this practice. Staff spoken with reported that any concerns are reported to the manager, to obtain medical advice, but did not demonstrate knowledge of the importance of providing a varied balanced and nutritional diet in service users daily routines. Staff spoken with, were not fully knowledgeable about the condition of Diabetes, therefore refresher training is recommended. Staff spoken with confirmed that they knew how to treat service users with respect at all times and described how privacy was promoted. Observations made of interaction between staff and service users on the day of the inspection supported this also. Records were in place of professional involvement such as GP visits, it is recommended that details of the actual consultation is documented with the record rather than in the progress notes to ensure a running history of information is present within the notes and not archived and that a comments section be used with weight records. We examined the medication records for two people. There had been some improvements noted to the systems in place, however there were several gaps on the Medication Records and generally poor record keeping evidenced of recording, handling, safekeeping, safe administration and Victoria Cottage Residential home DS0000063057.V355337.R01.S.doc Version 5.2 Page 14 disposal of medicines received into the care home, which suggested that not all medication has been administered according to the prescriber’s instructions which places the health and wellbeing of service users at the home at risk. For example, the medication administration Record [MAR] for one service user was viewed for week commencing 13/11/07 .On the prescription item Insulin Glargine 100iu/ML Vial, there were 4 dates without any signature or code 13th 14th 15th and 16th November 2007. The manager was unable to offer any explanation as to the reason for this. An entry in one service user’s care plan notes that on 23/11/07 that Daktakort cream was prescribed, but there was no entry of this prescription on the MAR from this date for this prescription, neither could the manager provide any evidence that the cream had been applied or evidence of the cream in stock on the premises. The managers new audit sheet does not indicate receipt of the medication on week’s 20/11/07- 4/12/07. There was another record sheet with no date, which identified Hydrocortisone cream 1 as received but this did not provide an audit trail of the item. The manager could not provide any confirmation of when the cream was supplied or why this was not recorded on the MAR. A MAR for another service user had hand written entries of four prescriptions, Dutasteride, Nicroperin [Aspirin], Atorvastatin and Paracetomol. Although two signatures were in place, there were no quantity amounts detailed on receipt and therefore no audit trail. The manager stated that she had not recorded details of medication on the audit sheet only on the MAR. The handwritten record dates, indicated as started on 14th of the month but there was no indication of which month, the dates were recorded up to the 26th and then state 4th- 9th. A new MAR dated 13/11/07 –10/12/07 contained entries from 27th November 2007, although there was no entry for Aspirin on the 27th the November 2007 and no entry or code for Atorvastatin on 28th November 2007. The evidence on the MAR suggests that staff had initially started to record medication administration on 4th November 2007 but had not scored through the preceding dates on the MAR. Entries were made up to the 6th November 2007 for Dutasteride and Paracetomol but only on 4th for Aspirin and Atorvastatin. There were no date entries at all for 10th 11th and 12th on the MAR. There were no signatures at all for administration of any of the prescribed medications for 7th 8th and 9th. Victoria Cottage Residential home DS0000063057.V355337.R01.S.doc Version 5.2 Page 15 The MAR indicated that staff had recorded medication entries from 14th-26th November 2007 on the first sheet, which was initially started on 4th November 2007, rather than on the MAR commencing 13/11/07. Therefore the records were confusing and did not provide an accurate record of medication received or administered. The manager has implemented a new audit system, but this was found to be inaccurate and undated in places and therefore did not provide an accurate audit trail of service users medication. A requirement set at the inspection on 11th June 2007 in respect of the above was found to have been complied with at the inspection undertaken on 9th October 2007 but there has clearly been a re-occurrence of non- compliance in these matters since this date and therefore the requirement once again set, now issued for Immediate action. There was now a safer storage system in place for Controlled Drugs but there were two entries in the Controlled Drugs records, which were not signed as administered by the person responsible, although the manager had signed the record that she had witnessed the medication being administered at the time. There must be an accurate record of all Controlled Drugs [or those to be treated as Controlled Drugs] to ensure that these are being administered safely and according to the service users prescription. There are continued concerns around the safety of medication practice at Victoria Cottage. Victoria Cottage Residential home DS0000063057.V355337.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 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 generally find the lifestyle experienced in the home matches their expectations and are helped to exercise choice and control over their lives, however improvement is needed for record keeping of food provided for and taken by service users to determine whether the diet is satisfactory in relation to nutrition. EVIDENCE: Information about service users social and leisure interests were seen in the care plans examined and The Newsletter ‘Victoria Cottage News’ viewed which informs service users and visitors of the events on offer for December 2007, which include a Carol service by the Beaver Cubs and a visit by Lowdham Church with the usual festive foods on offer. Staff and service users spoken with said that activities are provided such as cards dominos and quizzes when staff have time. One service user commented, that there could be more activities provided. Victoria Cottage Residential home DS0000063057.V355337.R01.S.doc Version 5.2 Page 17 The manager said that wherever possible service users are taken out, but that they are planning more outings, particularly on a one to one if needed. Records should be kept of what activities are actually provided and who has participated or refused. The Statement of Purpose states that all family and friends are encouraged to visit as often as possible, but are asked to avoid visiting at meal times. The visitor’s book provided a record of visitors and two visitors were seen on the day, although not spoken with during the inspection due to prioritising other inspection issues. Staff and service users confirmed that they were able to make choices about their daily routines and observation of practice on the day also confirmed this practice. Staff said that there is no pre -devised menu currently and that they decide on a daily basis what to cook. Service users said they enjoyed the food and one person said the meals are set, and that there is no choice but a variety of food is on offer, the service users also said that they get plenty of drinks and never get thirsty. There were not sufficient records to establish that service users are provided with a nutritional, balanced diet or that they are supported with nutritional or dietary needs to maintain their health and wellbeing. Service users who required assisted cutlery and cups were observed to have these provided and interaction between service users and staff was on the whole calm and positive. However, staff must be mindful of what they discuss and how they behave with service users present and maintain professional conduct at all times. Victoria Cottage Residential home DS0000063057.V355337.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are confident that their complaints will be listened to, taken seriously and acted upon. Service users are protected from abuse. EVIDENCE: Service users were confident that any complaints would be dealt with, but they had no reason to complain. Information on how to make a complaint was seen in the Statement of Purpose and Service User Guide. There were no complaints recorded in the complaints book and no complaints have been made to the Commission for Social Care Inspection. The manager reported that she was familiar with Safeguarding Adults Protocols and had the new Nottinghamshire protocols, which was viewed by us. Staff spoken with confirmed knowledge in what to do should they be concerned about the way a service user is treated and most said that they have undertaken training in safeguarding adults. Staff training records viewed confirmed that some staff had received training in safeguarding adults and that further training had been arranged. Victoria Cottage Residential home DS0000063057.V355337.R01.S.doc Version 5.2 Page 19 Risk assessments are in place for the use of bedrails and the home has a policy in place for restraint. The manager reported that she had not been able to obtain a signature from one service users relative for this and was advised by us to make reference to Regulation 17, Schedule 3, 3[q] Information of advocacy services was seen posted in the home and the Service Users Guide. Victoria Cottage Residential home DS0000063057.V355337.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users live in a comfortable and clean environment but there are some identified areas, which still may present a risk to service users health and safety. EVIDENCE: The outdoor space for service users, which was previously paved has been levelled and made safe. A gas fire in the lounge was protected by a fireguard, which is now fully secured. Victoria Cottage Residential home DS0000063057.V355337.R01.S.doc Version 5.2 Page 21 Although additional handrails have been fitted in the toilet and bathrooms areas, the support rails around the toilets and seat raisers were still not secure and it is recommended once again that the registered person obtain a professional assessment of the aids and adaptations within the home to ensure that they meet the needs of the current service users. Service users bedrooms were personalised and homely and service users said they were comfortable and that they had everything they needed. Disposable gloves and aprons were sited around the home, as were paper towels now in dispensers The manager stated that there had been no further visits from Environmental Health Officer since 29th January 2007. A range of toiletries and a disposable razor was observed left in a bathroom the first floor. The manager stated that the items belonged to night staff and that the bathroom is not used by service users, however the bathroom had not been secured and therefore the room was accessible to service users. The requirement set at the previous inspection is therefore partly met and a further timescale set for full compliance. The manager reported that new furniture was on order for the lounge and dining room. Victoria Cottage Residential home DS0000063057.V355337.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The number of staff provided meets service users needs, however training in care planning, food and nutrition and refresher training for staff in diabetes and medication will ensure staff have the necessary skills for safe practice. The homes recruitment practices are now robust and protect service users. EVIDENCE: The staffing hours, provided for the home were examined and found to meet service users needs. Additional staff are on duty for catering and domestic duties. Information provided by the manager in the Annual Quality Assurance Assessment states 14 care staff are employed and that three staff have achieved National Vocational Qualification [NVQ] level 2 or above and three staff are working towards an NVQ at the moment. Three staff member’s personal files were requested for inspection. All were satisfactory. Showing that staff, have the necessary checks and documentation in place. Victoria Cottage Residential home DS0000063057.V355337.R01.S.doc Version 5.2 Page 23 Training records were examined, these showed that staff have been provided with induction and training in Medication management, manual handling health and safety, fire safety, abuse awareness, dealing with aggression, Infection control, Dementia Care, First aid, pressure area, Equality and Diversity and food hygiene. Staff confirmed what was seen on records that they had undertaken the said training. It is recommended that the manager and staff undertake training in care planning, food and nutrition and refresher training for Diabetes, which will help them understand the needs of service users and support people in abetter way. An Immediate requirement has been set in respect of staff training/ competence in medication management due to the continued poor practice of staff in this area. [See Standard 9] Victoria Cottage Residential home DS0000063057.V355337.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32, 33, 35, 36, 37 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users live in a home, which is managed by a Registered Manager, who runs the home in the best interests of service users, however improvement is required to record keeping and storage of ‘sharp items’ to ensure the health, safety and welfare of service users is fully promoted and protected. EVIDENCE: The manager is registered with the Commission for Social Care Inspection has completed the Registered Managers Award. The staff and service users spoken with praised the manager highly. Victoria Cottage Residential home DS0000063057.V355337.R01.S.doc Version 5.2 Page 25 The manager does not have a deputy manager or administrator and tends to spend a lot of time working with the carers and service users, this limits the amount of time she can spend on her management responsibilities and should be reviewed in light of the outcomes of this inspection. The manager is currently undertaking an additional management course. Quality assurance monitoring is undertaken. Copies of service user surveys and provider visits were viewed, however only one survey had been returned from the recent distribution of surveys. Once all surveys have been compiled, the results should be fed back to service users and relatives and a copy of the evaluation feedback information be available for inspection. The survey should be expanded upon to include visiting professionals to the home. The manager stated that the home only deals with small cash held on behalf of four service users; records for these were examined and found to be satisfactory practice. Staff said that the manager speaks to them regularly and staff meetings are held, but there was limited evidence of appropriate supervision or appraisal as required by regulation. There was some written evidence viewed of one to one sessions held with staff, but the manager should formalise the process and seek training and support in this topic to ensure staff are appropriately appraised and supervised. Record keeping in respect of care planning, medication management, food and nutrition requires improvement. The manager reported in the Annual Quality Assurance Assessment that all servicing of equipment and health and safety checks were up to date. A lift servicing record and the fire risk assessment were observed to be in place. The requirement set at the previous inspection regarding storage of sharps is partly met. [See standard 19] Victoria Cottage Residential home DS0000063057.V355337.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X 2 X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 2 1 2 Victoria Cottage Residential home DS0000063057.V355337.R01.S.doc Version 5.2 Page 27 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 OP7 Regulation 14[2], 15 Timescale for action Ensure the assessment of service 08/02/08 users needs is kept under review and revised where service users needs change. Particularly in respect of service users nutritional needs, Blood Glucose monitoring and bowel healthcare. 2. OP7 OP9 15 Care Plans must be developed to include support plans for all healthcare needs and the medicines relating to them. Staff must follow these plans to ensure that residents’ healthcare needs are met This requirement with an original timescale of 4/12/07 was not met 3. OP9 13(2), 12[1][a] You must ensure that medication is administered according to the prescriber’s instructions to ensure the health and wellbeing of service users at the home. DS0000063057.V355337.R01.S.doc Requirement 08/02/08 13/12/07 Victoria Cottage Residential home Version 5.2 Page 28 This is an Immediate Requirement. Timescale by 3pm 13/12/2007 4. OP9 13(2), 17 There must be an accurate record of all Controlled Drugs [or those to be treated as Controlled Drugs] to ensure that these are being administered safely and according to the service users prescription. This requirement is a continued breach of regulation. Timescale 16/07/07 and 04/12/07 Not Met Now subject to warning letter issued 8/01/07 for compliance by 08/02/08 08/02/08 5 OP9 13(2), 17, 12[1][a] Ensure that you develop and maintain safe systems of the handling, administration, storage, recording and disposal of medication to ensure the health and wellbeing of service users at the home is protected. This is an Immediate Requirement. Timescale by 3pm 13/12/2007 13/12/07 6 OP9 13(2), You must ensure that only staff DS0000063057.V355337.R01.S.doc 13/12/07 Page 29 Victoria Cottage Residential home Version 5.2 OP30 18[1][a] who are assessed as trained and competent administer medication to ensure the health and wellbeing of service users at the home. This is an Immediate Requirement. Timescale by 3pm 13/12/2007 7. OP8 OP15 17, schedule 4[13] Ensure detailed records are kept of food eaten by service users to enable any person inspecting the record to determine whether the diet is satisfactory. Ensure disposable razors are treated as ‘SHARPS’ and appropriately stored and disposed of after use. Service users are placed at risk of Sharps items if they are not stored safely. 08/02/08 8 OP38 OP19 13(4a) 08/02/08 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 OP3 OP3 Good Practice Recommendations Person Centred Planning formats should be introduced for all service users to ensure their needs and wishes are being fully met. It is recommended that the agenda of equality and DS0000063057.V355337.R01.S.doc Version 5.2 Page 30 Victoria Cottage Residential home diversity is further developed in the home in general and that the assessment document is expanded to identify any gender, sexuality, race and cultural needs of individuals and how these will be met. 3 4 OP3 OP7 OP7 Ensure service users and /or their representative’s sign their involvement or agreement to the assessment or care plan. Progress notes should fully address and reflect the holistic needs of service users and their daily routines and choices made. Where authorisation is obtained for bedrails, the care plan/risk assessment should inform the service user or their representative of the possible risks of placing bedrails and be signed by all parties. Records should be kept of what activities are actually provided and who has participated or refused. Staff should be mindful of how their behaviours and conduct may detrimentally affect service users. It is recommended that the Registered Person obtain an assessment of the aids and adaptations within the home to ensure that they meet the needs of the current service users. Ensure staff have safe storage for their personal toiletries safely. Provide training for staff in care planning and food and nutrition and refresher training in diabetes. Further develop the quality assurance surveys on specific topics and demonstrate any action taken as a result of these. The manager should formalise the process for staff supervision and appraisal and seek training and support in this topic to ensure staff are appropriately appraised and supervised. 5 OP8 6 7 8 OP12 OP14 OP22 9 10 11 OP19 OP30 OP33 12 OP36 Victoria Cottage Residential home DS0000063057.V355337.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Victoria Cottage Residential home DS0000063057.V355337.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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