CARE HOMES FOR OLDER PEOPLE
Vishram Ghar 120 Armadale Drive Netherhall Leicester Leicestershire LE5 1HF Lead Inspector
Keith Williamson Unannounced Inspection 14th November 2007 09:30 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 Vishram Ghar DS0000063114.V354560.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. Vishram Ghar DS0000063114.V354560.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Vishram Ghar Address 120 Armadale Drive Netherhall Leicester Leicestershire LE5 1HF 0116 2419584 0116 2432745 mahesh@pattani.plus.com 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) BestCare Limited Ms Kusum Vala Care Home 40 Category(ies) of Dementia (40), Mental disorder, excluding registration, with number learning disability or dementia (40), Old age, of places not falling within any other category (40), Physical disability (40) Vishram Ghar DS0000063114.V354560.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The registered person may provide the following categories of service only: Care Home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are: Old age, not falling within any other category - Code OP Dementia - Code DE Mental Disorder - Code MD Physical Disability - Code PD The maximum number of service users who can be accommodated is 40 10th July 2007 2. Date of last inspection Brief Description of the Service: Vishram Ghar care home is registered to care for up to forty older persons who may have Dementia, Physical Disabilities or Mental Health issues in an Asian lifestyle environment. The property is purpose built and is situated in the residential area of Netherhall close to shops and other facilities. The home is easily accessible for private and public transport. The home consists of two floors accessible by use of the stairs and passenger lift. There are a variety of facilities in the home including dining and lounge space. The home comprises thirty-eight single bedrooms two with en suite facilities and one double bedroom without en suite facility. A garden is situated to the rear of the premises. The Statement of Purpose and Service User Guide and the current inspection report are available for new residents. (This is information about how the home is managed and the facilities provided.) A copy of those and the last report are available along with other individual information in the foyer of the home. At the time of this visit, the range of fees was between £297 and £440 per week. Vishram Ghar DS0000063114.V354560.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The focus of the inspections is on outcomes for residents and their views of the service provided. The primary method of Inspection used was ‘case tracking’ which involves selecting a sample number of residents and tracking the care they received through looking at their records, talking with them where possible, and looking at their accommodation, in this case four residents were chosen. This inspection took place over one day, commencing at 9.00am and took six and one half hours to complete. One inspector conducted the inspection (or site visit). An opportunity was taken to look around the home, view records, policies and care plans and to talk to residents and staff. Information was gathered prior to the site visit from sources such as residents, their relatives, staff comment cards and the pre inspection questionnaire from the registered manager. Twenty one of residents were seen and eight spoken with during the inspection process. An interpreter was used at the inspection. What the service does well: What has improved since the last inspection?
Vishram Ghar DS0000063114.V354560.R01.S.doc Version 5.2 Page 6 A copy of the contract or terms and conditions of the residents stay, has now been placed in residents’ files. Residents’ assessments are now more detailed, which ensures that the care plans are more appropriate. Care plans are now reviewed on a more regular basis, which ensures that the care plan reflects the changing needs of the resident. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Vishram Ghar DS0000063114.V354560.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Vishram Ghar DS0000063114.V354560.R01.S.doc Version 5.2 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 & 6 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The assessment process for residents is now more detailed; resulting in accurate information for staff to ensure care needs shall be met. The information in the Statement of Purpose, Service User Guide and Contract is not reproduced in a language appropriate for all residents in the home; resulting in a lack of information for residents being admitted to the home. EVIDENCE: The Statement of Purpose, which sets out the latest aims, objectives and philosophy of the home, about its services, facilities, and current staffing, was available for inspection on this occasion. The Statement of Purpose, Service User Guide and residents’ Contract have not yet been printed in a language or format understood by residents or their representatives. Vishram Ghar DS0000063114.V354560.R01.S.doc Version 5.2 Page 9 Of the residents’ files that were looked at all had a contract or similar document in place. Assessment information which is gathered by the manager before a resident is admitted is now more detailed and provides enough a basis for a care plan. The home does not provide facilities for intermediate care. Vishram Ghar DS0000063114.V354560.R01.S.doc Version 5.2 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Residents are now looked after better in respect of their care planning and care plan reviews. Inaccuracies in the medication recording and poor information in policies and procedures means that residents are still at risk from medication errors. EVIDENCE: Care plans for the residents now have enough detail to help the staff take care of the residents’ health and personal care needs, though more work needs to be done on social care needs. Care plans are now reviewed more regularly. There is a lack of health care monitoring, with some records covering weight gain and loss, but no nutritional monitoring. Care plans also lack detail for individual residents teeth, denture and foot care. Access to the doctor is good, with regular visits made to the home.
Vishram Ghar DS0000063114.V354560.R01.S.doc Version 5.2 Page 11 The medication administration records (mar charts) which staff use to record what tablets a resident is given, still had a few missing signatures. Records are kept by staff of medication brought from the chemist, but medication already in the home was not added to the records. This meant staff couldn’t check that all residents had the correct medicines. For instance staff had signed they had given one tablet on each of the three days that month, yet there was only one, out of the tube of twenty-eight. Records are in place for residents who keep their own medication, though there were no risk assessments to tell the staff what to do if something went wrong. The general policies and procedures to help staff give the correct medicine are in place and have been recently reviewed. These are still not good in instructing the staff to help in the ordering process, nor in for residents taking their own medication. The privacy and dignity of residents is good with toilet and bathroom door locks that fit appropriately. Staff were witnessed to knock and wait prior to entering residents bedrooms, and were heard to speak respectfully to residents. Vishram Ghar DS0000063114.V354560.R01.S.doc Version 5.2 Page 12 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): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Most residents enjoy, experience and participate in activities and interests, and are supported to maintain their preferred individual daily routines and choice of lifestyle with the support of the staff. Lack of assessment, care planning and researched activities, leaves residents with Dementia lacking in stimulation. EVIDENCE: Activities are planned and provided for the majority of residents, religious events in the lounge, and one resident stated the outside speakers “I wish we could have our books back again” though it is understood trips to the library continue, and residents encouraged to bring back books in their first language. There is a lack of detailed social care information in care plans for residents suffering with Dementia, little information is gathered at the point of assessment, and no enteries could be found in the care plans, so staff are unaware of how to best assist individual residents within this group. Visiting is unrestricted with a number of relatives visiting on the day.
Vishram Ghar DS0000063114.V354560.R01.S.doc Version 5.2 Page 13 Staff promote choice, where residents that are capable of making choices they do so, assisted by staff where necessary. Meals and meal times are well organised, though the menu choices are not discussed in advance at the residents’ and relatives’ meetings. These could be made available on a chalkboard or something similar to remind residents of their daily choices. The cook produces meals in line with residents’ dietary preferences and information gathered. The meals offered to the residents match the cultural diversity of the residents. Vishram Ghar DS0000063114.V354560.R01.S.doc Version 5.2 Page 14 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 poor This judgement has been made using available evidence including a visit to this service. Residents’ are not still protected by appropriate complaints and adult protection policies, and staff’s lack of knowledge in proper moving and handling techniques. EVIDENCE: Residents who were spoken with stated that they feel comfortable discussing any concerns with the home’s manager or staff. The complaints procedures are available for residents and visitors, and are included in the Statement of Purpose and Service User Guide, though these documents require to be reviewed. The complaints procedure is not available in any language other that English (also see the comments in Section 1 Choice of Home). There have been no further complaints to the home since the last visit. The Commission for Social Care Inspection has received no complaints for the same period of time. Staff are aware of some Adult Protection information on abuse and whistleblowing. However staff were seen to be moving residents, by lifting them without the aid of a hoist, and this puts the resident and staff at risk of harm. Vishram Ghar DS0000063114.V354560.R01.S.doc Version 5.2 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. A comfortable standard of accommodation is provided for most of the residents. EVIDENCE: The home is relaxed and spacious and gives a large amount of public space for the people who live there. The grounds are well maintained, and the programme of refurbishment is nearly complete. The seats in the lounges are all the same height and not suitable for some of the residents who cannot sit in comfort, due to their height. The staff continue to have a good knowledge of cross contamination and cross infection issues. A range of protective clothing is available to ensure residents’ safety in the home.
Vishram Ghar DS0000063114.V354560.R01.S.doc Version 5.2 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29 & 30 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Poor care staffing levels and lack of specialised training places residents and staff at risk in the home. EVIDENCE: Looking at the staff rota, this showed that four care staff were on duty at the time of the visit. The Responsible Individual stated that an activities organiser had been employed, but on further discussion the Inspector found this was a member of staff employed as one of the four carers on duty. Current staffing does not allow for the provision of social care, or proper moving and handling (hoisting) of residents. Please refer to Standard 18 for further information. Staff training has provided more than the minimum of care staff undertaking the National Vocational Qualification level two in care, with 54 of care staff trained. However staff training in moving and handling and vulnerable adult issues has not been effective in making staff aware and keeping the residents and staff safe in the home. Vishram Ghar DS0000063114.V354560.R01.S.doc Version 5.2 Page 17 The recruitment process is well managed and secure, with evidence of completed application forms, references, proof of identification and the appropriate Criminal Records Bureau checks seen on staff files. Vishram Ghar DS0000063114.V354560.R01.S.doc Version 5.2 Page 18 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): 33, 36 & 38 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The management approach does not promote effective care practice in the home for residents’ care and protection. EVIDENCE: Quality assurance questionnaires have been distributed to residents and their relatives, and the outcomes have now been gathered together and are available in the foyer of the home, but as yet not added to the Service User Guide. Vishram Ghar DS0000063114.V354560.R01.S.doc Version 5.2 Page 19 Staff supervision is currently not undertaken in the home. The Responsible Individual indicated that staff appraisal is due to commence shortly. A sample of accident reports were seen and appeared to have been completed appropriately, and there is accuracy between these and the residents’ individual daily records. Fire records were viewed and the weekly fire alarm tests and emergency lighting were found to be up to date, however the fire risk assessment has still not been updated. This was a requirement at the last visit, and a visit from the Fire Authority has been requested to follow up this issue. There is still no up to date gas certificate for the home. The annual portable appliance tests (pat tests) and five-year electrical safety test have still not been renewed. There are blending valves in place on resident areas throughout the home, however water temperatures are not tested to ensure they are working appropriately. Again these were issues at the last visit that have not been acted on. Vishram Ghar DS0000063114.V354560.R01.S.doc Version 5.2 Page 20 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 1 1 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 1 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 2 X X X X X X 3 STAFFING Standard No Score 27 1 28 X 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X X 1 X 1 Vishram Ghar DS0000063114.V354560.R01.S.doc Version 5.2 Page 21 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 OP1 Regulation 4 (1) Requirement The Statement of Purpose must be produced in a format or language accessible to the majority of residents in the home. This is to ensure the full information is available to the resident prior to any stay in the home commencing. (This requirement with an original timescale for action of 24/08/07 remains unmet) 2 OP2 17 (1) a The contract or terms and conditions of the residents stay, must be produced in a format or language accessible to the majority of residents in the home. This is to ensure the full information is available to the resident prior to any stay in the home commencing. (This requirement with an original timescale for action of 24/08/07 remains unmet)
Vishram Ghar DS0000063114.V354560.R01.S.doc Version 5.2 Page 22 Timescale for action 31/12/07 31/12/07 3 OP9 13 (2) There must be an accurate policy 31/12/07 and procedure how all residents should be assisted to administer their own medication, and the checks staff should make to ensure they are safe to do so. All medication must be administered as prescribed. This would ensure safe dispensing and administration of medication to residents in the home. (This requirement with an original timescale for action of 24/08/07 remains unmet) 10/12/07 4 OP9 13(2) 5 OP12 12 (1 & 3) Information for residents’ pastimes must be researched and provided to meet the needs and wishes of residents. This shall ensure residents are offered activities at an appropriate level for their intellect. (This requirement with an original timescale for action of 24/09/07 remains unmet) 31/12/07 6 OP16 22 A complaints procedure, which is appropriate to the needs of residents, must be put in place. This would ensure anyone wishing to complain, has the correct information to do so. (This requirement with an original timescale for action of 24/08/07 remains unmet) 31/12/07 Vishram Ghar DS0000063114.V354560.R01.S.doc Version 5.2 Page 23 7 OP18 18 (1) a Staff awareness of Adult protection issues, must be heightened. This is to enable residents’ to be protected in the home. (This requirement with an original timescale for action of 24/10/07 remains unmet) 31/12/07 8 OP19 23 (2) a The seating in the home must be made available to suit the individual needs of residents. This is to ensure residents are comfortable in the home The staff numbers on duty must reflect the needs of the resident group at that time. This to ensure to residents are safe in the home. The staff training in the home must ensure all staff have the correct information and training to care for residents appropriately. This is to enable all residents and staff to be safe in the home. Staff must be appropriately supervised, and aspects of practice, the philosophy of the home, and career development covered. This would ensure staff employment policies, induction and training were all put into practice in the home. 31/12/07 9 OP27 18 (1) a 10/12/07 10 OP30 18 (1) a 31/12/07 11 OP36 18 (1) a 31/12/07 Vishram Ghar DS0000063114.V354560.R01.S.doc Version 5.2 Page 24 12 OP38 17 (2) Periodic reviews of the fire risk assessment must be performed regularly. This is to ensure the safety of residents. (This requirement with an original timescale for action of 24/08/07 remains unmet) 04/12/07 13 OP38 17 (2) The Responsible Individual must 04/12/07 ensure all health and safety checks are undertaken regularly, and certificates required to prove the validity of these tests, be available for inspection. This is to ensure a safe environment for the residents. (This requirement with an original timescale for action of 24/08/07 remains unmet) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP9 Good Practice Recommendations It is recommended that a written record is maintained of all training, supervision and assessment provided to staff regarding the safe handling, storage and administration of medication and that further accredited training be provided. It is recommended that care plans be produced in a format or language appropriate for all staff to understand. 2 OP7 Vishram Ghar DS0000063114.V354560.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection East Midland Regional Office Unit 7 Interchange 25 Business Park Bostocks Lane Nottingham NG10 5QG 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
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