CARE HOMES FOR OLDER PEOPLE
Vishram Ghar 120 Armadale Drive Netherhall Leicester LE5 1HF Lead Inspector
Keith Williamson Unannounced Inspection 21st January 2008 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.V356906.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.V356906.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Vishram Ghar Address 120 Armadale Drive Netherhall Leicester LE5 1HF 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) 0116 2419584 0116 2432745 mahesh@pattani.plus.com 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.V356906.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 14th November 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 premise 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. At the time of this visit, the range of fees was between £297 and £440 per week. Vishram Ghar DS0000063114.V356906.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 site visit took place over one day, commencing at 9.30am and took five hours to complete. An opportunity was taken to look around the home, view records, policies and care plans and to talk to residents and staff, with the aid of an interpreter. 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. Nine of the residents were seen and three spoken with during the visit. What the service does well: What has improved since the last inspection?
A number of documents giving information to resident prior to and after they move into the home are now produced in other formats. These include the Service User Guide, contract or terms and conditions and complaints information. Vishram Ghar DS0000063114.V356906.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Vishram Ghar DS0000063114.V356906.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.V356906.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 poor This judgement has been made using available evidence including a visit to this service. The Statement of Purpose, and assessment process for residents is not detailed or effective; resulting in a lack of accurate and detailed information for staff to ensure care needs shall be met. 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, has not yet been printed in a language or format understood by residents or their representatives. The Service User Guide and residents’ Contract have been reproduced in an alternative language, and were seen in use in the files of the residents.
Vishram Ghar DS0000063114.V356906.R01.S.doc Version 5.2 Page 9 Assessment information, which should be gathered in detail by the manager before a resident is admitted, is not detailed enough to provide a basis for a care plan or ensure a persons needs can be met by staff in the home. The poor assessment process also results in people being admitted to the home, with needs greater than can be met by the staff. The certificate of registration, Statement of Purpose and staff training are also deficient in showing how these specialist needs could be met. The home does not provide facilities for intermediate care. Vishram Ghar DS0000063114.V356906.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 poor This judgement has been made using available evidence including a visit to this service. Residents are not looked after well in respect of their care planning. Gaps and inaccuracies in the medication recording and information means that residents are at risk from medication errors. EVIDENCE: Care plans for the residents did not include enough detail for staff to enable them to undertake health, personal and social care needs, on a consistent basis. Risk assesments were not in place, for issues such as monitoring of long-term conditions including diabetes. Specific health care information is not in place, for instance nutritional and diet information was not seen in any of the files. The medication administration records (mar charts) had no missing signatures on this visit.
Vishram Ghar DS0000063114.V356906.R01.S.doc Version 5.2 Page 11 Medication received from the chemist is recorded though there are still no regular audits in place to ensure the proper medication administration process is taking place. Medication policies and procedures are in place but have not been reviewed, to ensure adequate instruction to staff on the proper process of ordering, administering and disposing of unwanted medication in the home. The privacy and dignity of residents is good with those residents interviewed agreeing the staff were sensitive to their needs. Staff were witnessed to knock and wait prior to entering residents bedrooms, and were heard to speak respectfully to residents. Vishram Ghar DS0000063114.V356906.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): 12 & 15 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Lack of assessment, care planning and researched activities, leaves residents with Dementia lacking in stimulation. Menu choices are not made widely available in the home, resulting in some residents being unaware of food choices available to them. EVIDENCE: 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. There is still no menu information available for the residents in the home, other than on the notice board. This is not reproduced in print large enough for most residents to understand. Menus continue to be compiled up following the regular residents’ and relatives meetings. Comments from residents included “the food is good here, I’m happy”.
Vishram Ghar DS0000063114.V356906.R01.S.doc Version 5.2 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Residents’ are not still protected by the appropriate adult safeguarding policies, and staff’s lack of knowledge in proper medication handling techniques and risk assessment. EVIDENCE: There have been no complaints made to the home since the last visit. The Commission for Social Care Inspection has received no complaints for the same period of time. The complaints procedure is now available in an alternative format, though residents admitted recently stated they had no knowledge of this document. Staff are still not aware of, or been trained sufficiently in safeguarding adults procedures; this places residents at risk of abuse in the home if staff do not recognise and respond appropriately to situations in the home. Vishram Ghar DS0000063114.V356906.R01.S.doc Version 5.2 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home provides a relaxed and spacious environment that is appropriate to the specific needs of the people who live there. The building and grounds are well maintained, and specialist aids and equipment are provided to meet the needs of the people who use the service. EVIDENCE: A maintenance programme is in place, and projected work is in place to ensure the improvement in the home to date, is sustained for the future. The replacement of some of the chairs in the lounge areas, have been added to the programme. Vishram Ghar DS0000063114.V356906.R01.S.doc Version 5.2 Page 15 Staff when spoken with 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.V356906.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, 30 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The staffing numbers and training courses are not effective in ensuring resident safety 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 interviewed, and would commence employment on evidence of certain security checks. These are made by the home prior to all staff commencing employment. The current staffing still does not allow for the provision of social care, or stimulation of residents so employing someone in this role could bring about improvement in outcomes for people. The Responsible Individual explained how the staff training programme had been compiled. Staff have completed a number of courses, including a course in medication administration. Please also refer to Health and Personal care for further information. Vishram Ghar DS0000063114.V356906.R01.S.doc Version 5.2 Page 17 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, though the outcomes have not been circulated to interested parties, nor added to the Service User Guide. Staff supervision had not commenced, even though this has been required in the last two inspection reports.
Vishram Ghar DS0000063114.V356906.R01.S.doc Version 5.2 Page 18 The Responsible Individual stated that staff appraisal was due to commence following the inspectors visit on the 10th of July 2007, again this has not commenced. Fire records were viewed and the weekly fire alarm tests and emergency lighting were found to be up to date, the fire risk assessment has also been brought upto date. Vishram Ghar DS0000063114.V356906.R01.S.doc Version 5.2 Page 19 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 3 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 1 X X X X X X 3 STAFFING Standard No Score 27 1 28 X 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 1 X X 1 X 3 Vishram Ghar DS0000063114.V356906.R01.S.doc Version 5.2 Page 20 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 and 31/12/07 remains unmet) 2 OP3 14 (1) a, b, c & d Assesments of a persons needs must be fully completed prior to moving into the home. This is to ensure the staff have the abilities, and equipment to meet those individual needs. (This requirement with an original timescale for action of 31/12/07 remains unmet) 07/02/08 Timescale for action 07/02/08 Vishram Ghar DS0000063114.V356906.R01.S.doc Version 5.2 Page 21 3 OP7 12 (1) All care plans must be sufficiently detailed to enable staff to fully care for individual residents personal, social and emotional care. This would ensure that all staff had sufficient information to meet the residents’ personal care needs. 14/02/08 4 OP7 13 (4) b All risk assessments must be sufficiently detailed to enable staff to fully protect residents. This would ensure staff were aware how to reduce risks in the home. 14/02/08 5 OP8 12 (1) Care plans must be sufficiently detailed giving adequate instruction for staff to provide individual health monitoring to residents. This would ensure residents that deficiencies in health care would be referred for appropriate action. 14/02/08 6 OP9 13 (2) There must be an accurate policy 14/02/08 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. This is to ensure medication is administered safely. (This requirement with an original timescale for action of 31/12/07 remains unmet) Vishram Ghar DS0000063114.V356906.R01.S.doc Version 5.2 Page 22 7 OP9 13(2) 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, 10/12/07 and 31/12/07 remains unmet) 07/02/08 8 OP9 13(2) Staff must ensure when copying 07/02/08 medication onto MAR charts, that the wording is copied exactly. This is to ensure the appropriate medication is given by the correct route at the correct time. (This requirement with an original timescale for action of 31/12/07 remains unmet) 9 OP12 12 (1 & 3) Information in relation to 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 and 31/12/07 remains unmet) 28/02/08 10 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 and 31/12/07remains unmet) 07/02/08 Vishram Ghar DS0000063114.V356906.R01.S.doc Version 5.2 Page 23 11 OP27 18 (1) a The numbers of care staff must reflect the needs of the resident group. This would ensure staff have the appropriate time to care for residents. 07/02/08 12 OP30 18 (1) a 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. (This requirement with an original timescale for action of 31/12/07 remains unmet) 28/02/08 13 OP33 24 The outcome of any quality assurance exercise is used to inform any prospective residents to the home. This would ensure that residents could comment on, and influence the development of the home. 14/02/08 14 OP36 18 (1) a Staff must be appropriately supervised, and aspects of practice, the philosophy of the home, and career development must be covered. This would ensure staff employment policies, induction and training were all put into practice in the home. (This requirement with an original timescale for action of 31/12/07 remains unmet) 14/02/08 Vishram Ghar DS0000063114.V356906.R01.S.doc Version 5.2 Page 24 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 OP7 Good Practice Recommendations It is recommended that care plans be produced in a format or language appropriate for all staff to understand. 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 the Registered Manager has a full working knowledge of the vulnerable Adults Policy ‘No Secrets’ and that further training regarding the protection of vulnerable adults is provided to all care staff. 2. OP9 3. OP18 Vishram Ghar DS0000063114.V356906.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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