Inspection on 21/07/09 for Vishram Ghar

This inspection was carried out on 21st July 2009.

CQC found this care home to be providing an Adequate service.

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

Vishram Ghar 05/01/10

Vishram Ghar 05/02/09

Vishram Ghar 29/02/08

Vishram Ghar 21/01/08

Vishram Ghar 14/11/07

Vishram Ghar 10/07/07

Vishram Ghar 21/06/06

Vishram Ghar 18/10/05

Vishram Ghar 27/06/05

Similar services:

Trevayler Residential Care Home

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE Vishram Ghar 120 Armadale Drive Netherhall Leicester LE5 1HF Lead Inspector Linda Clarke Key Unannounced Inspection 09:30 21st and 22nd July 2009 DS0000063114.V376622.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Vishram Ghar DS0000063114.V376622.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Vishram Ghar DS0000063114.V376622.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 Manager post vacant 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.V376622.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 5th February 2009 2. Date of last inspection Brief Description of the Service: Vishram Ghar is a care home 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 situated in the residential area of Netherhall close to shops and other facilities. The home is easily accessible by private and public transport. The home consists of two floors accessible by use of stairs and passenger lift. There are a variety of facilities in the home including dining and lounge space. The majority of bedrooms are single bedrooms, of which two have en-suite facilities and there is one double bedroom. Information with regards to fees is available by contacting Vishram Ghar. The full details about the home and any specific requirements can be obtained from the home in the form of ‘Statement of Purpose’ and ‘Service User Guide’, which are available in English, Gujarati, Punjabi and can be made available in other languages. The latest Inspection Report from the Care Quality Commission is available at the home. Vishram Ghar DS0000063114.V376622.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is one star. This means the people who use this service experience adequate quality outcomes. ‘We’ as it appears throughout the inspection report refers to the ‘Care Quality Commission’. The inspection process consisted of pre-planning the inspection, which included review the Annual Quality Assurance Assessment (AQAA), which is a selfassessment tool completed by a representative of the service, reviewing previous inspection reports, and any information we have received. The unannounced site visit commenced on the 21st July 2009, and took place between 09:30 and 17:30, with a further visit on the 22nd July 2009 between 10:00 and 13:00. The focus of the inspection is based upon the outcomes for people who use the service. The method of inspection was ‘case tracking’. This involved identifying people with varying levels of care needs and looking at how these are being met by the staff at Vishram Ghar. Three people accessing services were chosen and discussion with held with two of them along with others living at the home. We sent surveys to twenty people living at the home and their relatives of which none were returned. We sent three surveys to health care professionals of which one was returned; we received three surveys of the sixteen sent to staff who work at the home. We were accompanied by a Pharmacy Inspector who looked at medication records and storage, and also spoke to some people who live at the home and staff about medication. An interpreter joined us for part of the first day to enable us to speak with people who live at the home, and found out their views about the care and support they receive at Vishram Ghar. What the service does well: Vishram Ghar is a residential care home situated in a residential area, and offers an ‘Asian Lifestyle’ to suit people from an Asian background, culture or lifestyle. Vishram Ghar DS0000063114.V376622.R01.S.doc Version 5.2 Page 6 Information about Vishram Ghar is available in various Asian languages such as Gujarati and Punjabi. Cultural needs of people are met with regards to meals and religious beliefs, and people are supported by staff that are able to speak a number of Asian languages and dialects. What has improved since the last inspection? What they could do better: Care plans need to be updated using the new format, and should include the wishes, expectations and views of people who require care and support, including peoples preferred daily routines. Improvements need to be made with reference to people with dementia, so that staff know how to provide appropriate support, including distraction techniques when people become Vishram Ghar DS0000063114.V376622.R01.S.doc Version 5.2 Page 7 disorientated. Choices people make about the management of their medication and assessments to determine risks where people wish to manage their own medication need to be more robust. These changes will improve the quality of life people living at the home receive, which would be based on their individual expectations and choices. Lifestyle choices need to be increased by enabling people to have greater access to activities within the home, by increasing the hours the activity organiser works and by ensuring there are sufficient staff to assist with activities. Access to community resources including attending cultural and religious events need to be increased, by providing additional and flexible staffing arrangements through the availability of accessible transport. The environment could be improved by considering how the use of patterns and colours impacts on the welfare of people with dementia, and by creating a more homely environment in which people live. The ethos of the home could be improved by encouraging staff to comment on the day to day running of the home, by giving them the opportunity to contribute to the agenda of their supervisions and staff meetings, and by encouraging staff to contribute to meetings and share their views and opinions. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Vishram Ghar DS0000063114.V376622.R01.S.doc Version 5.2 Page 8 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.V376622.R01.S.doc Version 5.2 Page 9 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3. Standard 6 is not applicable. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The assessment process enables the home to determine whether the needs of people can be met, ensuring that people receive the support they need. EVIDENCE: We wanted to find out if the assessment process helped to identify people’s care needs. We looked at the records of three people who lived at the home; all had had an assessment of their needs carried out by a Social Worker before they moved in, we did find in one instance that the assessment had not been reviewed to reflect the current change in circumstances for that person. Vishram Ghar DS0000063114.V376622.R01.S.doc Version 5.2 Page 10 We were told that a Senior Carer will also undertake an assessment of the persons needs before someone moves into Vishram Ghar, the previous Key Inspection identified that the assessment process was not robust and that people undertaking the assessment had not received sufficient training to enable them to carry out an assessment effectively. We found by looking at records that the assessment process has been revised with a new assessment form that covers a wider range of topics. The Registered Person of Vishram Ghar had until recently employed a consultancy firm to assist them in reviewing practices within the home, which included the assessment process. We were advised that the consultancy firm had provided guidance on the completion of assessments to relevant personnel. We looked at the records of three people, which included someone who had recently moved into Vishram Ghar, to see the effectiveness of the new assessment process. The assessment was more comprehensive and had been used to develop an initial care plan, which was implemented when the person moved into the home. The assessment carried out by the representative of the home detailed what aspects of the person’s lives they could manage independently and the areas where support and guidance would be required. Information also included their ability to communicate and their preferred language, and equipment the person needed to remain safe and promote their independence. We spoke with people about their decision to move into the home, people told us that their family had found the place for them and had visited before they moved in, and that they were satisfied with their families’ choice. Vishram Ghar does not provide intermediate care. Vishram Ghar DS0000063114.V376622.R01.S.doc Version 5.2 Page 11 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Vishram Ghar have access to health and personal care including medication; however the lack of robust care planning and documentation has the potential to impact on the quality and consistency of care people receive. EVIDENCE: We wanted to find out how the health and personal care needs of people living at the home were met. We spoke with people living at the home and observed the care and support provided by staff, we also looked at the care plans and records of three people. The care plans that we looked at, started by providing information about a persons life before they moved into the home, including information as to their Vishram Ghar DS0000063114.V376622.R01.S.doc Version 5.2 Page 12 employment, family, hobbies and interests, this enables staff to understand what’s important to the person, and how their experiences influence their choices and decisions. We noted that some improvements have been made to care plans, but found that care plans for many people had not been reviewed or updated. The Registered Person had until recently engaged the services of a management consultancy firm to help them review policies and practices in the home, which included reviewing the format of care plans and had provided guidance to staff on how to complete care plans. One of the care plans that we looked at was of the new style and format, and had been developed from the assessment carried out by the home and the Social Worker. The care plan had been developed to focus on specific elements of care and support, and had been reviewed regularly. The care plan provided limited information as to how staff were to support the person with their confusion, and this is an area for improvement. The two other care plans that we looked at were not in the new format style, but did give an overview as to the persons needs, and the support and care they needed with regards to their health. We spoke with one person whose records we had viewed, they told us about the care and support they received, which was an accurate reflection of the information recorded within their care plan. They told us that staff responded when they rang the bell, and that two female staff assisted them with their personal care and that they used a hoist. The person had pressure relieving equipment in place, which included a mattress for their bed. A review of the persons needs had been carried out by Social Services and had concluded that the persons needs were being met, and records showed that the person themselves had attended and contributed to their review. We were not able to speak with one of the people whose records we had viewed due to their health care needs; their care plan did not provide a comprehensive account as to how staff needed to support and care for that person with regards to their dementia. We spoke with three people whose records we did not view, they told us:“All carers are equal, and they look after me well. They give me refreshment when I need it and staff ask how I am. I decide when I get up and go to bed.” “Anything I need staff will bring. All carers are good. No complaints. I like living at the home. Staff respond when I ring the call bell.” Surveys completed by staff told us that they are confident that the information they are given in care plans enables them to meet the needs of people living at the home. Vishram Ghar DS0000063114.V376622.R01.S.doc Version 5.2 Page 13 We observed staff throughout the day talking with people in their first language, which for a majority of people is Gujarati or Punjabi, many of the staff are able to communicate well in both languages. We heard call bells ring during our visit, and these were responded to within a reasonable period of time. We noted that staff supported people with personal care needs, taking them to the toilet at regular intervals or when the person requested. Records we viewed showed us that people have access to health care services which include Chiropodist, Dentist and General Practitioner, and where necessary people were supported to attend hospital appointments. The survey we received from a health care professional told us that the social and health care needs were regularly reviewed and monitored with regards to their specialist area and that staff sought and acted upon their advice. We noted that risk assessments had been undertaken for some people, whilst risk assessments detailed the outcome of the assessment, there was no evidence as to how the decision had been reached or the criteria used to determine the outcome; therefore there is no evidence that the risk assessment process is robust. We had a tour of the home and found that all bathrooms and toilets were in working order and contained soap dispensers to prevent the spread of infection. Anti-bacterial gels were located in the home, for visitors and staff to use. Evidence collated by the Pharmacist Inspector relating to medication handling at the home is as follows: The home organises and takes responsibility for most people medicines. The administration records sheets for 3 people were viewed in depth and appeared to be in order as medicines were given as prescribed. Anomalies did arise in the accounting of medicines on these sheets. The self-administration policy stated the home provided a lockable cupboard in service user’s room to store medication. This was seen for two people who administered their own pain relief tablets. Risk assessments for this self-administration had been carried out but were not robust. This could people at the home at risk. Through an interpreter it was established that these two people were capable of dealing with this medicine and they knew about the maximum doses. The reasons why they decided to look after their own pain relief tablets was due to dignity and choice issues. The home had not kept this information in their individual care plans. A GP who attended weekly to see service users was spoken to. He stated that staff would request that he sees specific patients but he would also initiate Vishram Ghar DS0000063114.V376622.R01.S.doc Version 5.2 Page 14 treatment before the visit too. He expressed that “the systems seem to work well and he doesn’t have any concerns”. All the medicines that are required to be stored in the fridge and have a short in use date, did have the date of opening marked on the packaging and were kept in a clinical fridge. The senior carer when asked was unable to say what the desired temperature range was to keep medicines effective. She informed us that she was shown how to take the readings of the thermometer attached to the clinical fridge. Reading of 13.2’C was being recorded as the maximum reading since 24/06/09. No records were made of any action taken to rectify the high temperature which could have caused the medicines stored to be less effective. This meant that some medicines may not work as well as they should have as stored at slightly higher than recommended temperature. Controlled drugs were being managed well at the home although the cabinet used needed to be more securely bolted to the wall. A person was using an oxygen unit. There was a no smoking sign on the unit in the room but the door to the room did not show any warning signs. This could cause a problem if there is a fire related incident at the home. The senior carer was asked how the home deals with medicines that are purchased over the counter. She said they would arrange for a prescription or a GP approval. She seemed a little confused by the Homely remedy list in the policy and did not know what one of the items listed was to be given for. A service user was prescribed a cream for relief of dry skin. This was being applied by carers twice a day and the care officers would sign the record sheets. No information was available in the individual care plan regarding this care need. Four medication audits carried out indicated that there were anomalies in the accounting of medication. Even though systems are in place to account for new medicines and carry forward balances from previous months supply these records are not accurately reflecting all the stock levels versus what is being given. A medication audit folder was seen and it was noted that signatures on the record sheets and stock levels are checked. The area manager stated that audits checks are done on a random basis and evidence is collected as part of his statutory checks. A senior carer stated that her induction training consisted of her then manager showing her how to complete a medication administration record sheet and telling her what medication people take. She had read the home’s policy but Vishram Ghar DS0000063114.V376622.R01.S.doc Version 5.2 Page 15 could not confirm this with any training records. She had also recently received some training on Mental Capacity Act deprivation of liberty safeguards, which was delivered by Leicester City Council. Vishram Ghar DS0000063114.V376622.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Activities and meals are provided for people to engage in which are reflective of their cultural and religious beliefs but access to community activities is restricted by staffing numbers and lack of accessible transport this compromises the quality of life people receive. EVIDENCE: We wanted to find out how people spend their day, and how the staff working at the home support people to make decisions and stay in contact with relatives and friends, we did this by observing people throughout our visit, talking with people at the home and by looking at the care plans and records of three people. The foyer is decorated with various statues and images of Hindu Gods and Asian style ornaments, with radios and televisions being tuned to Asian channels. Displayed on the wall in the foyer are dates for when Indian Vishram Ghar DS0000063114.V376622.R01.S.doc Version 5.2 Page 17 devotional songs and religious music and hymns are sung known as Bhajans and Kirtans. We walked around the home to see where people were, a majority of people were sat in one of the two lounges on the ground floor, with some people remaining in their bedroom. In lounge one we found people watching an Asian television channel, the lounge remains bland, with little interest other than the television for people to look at, easy chairs are arranged around the perimeter of the room, restricting conversation and interaction between people living at the home. We found that people in lounge two were also watching an Asian television programme, this room has ornaments and pictures reflective of Asian cultures and beliefs, providing areas of interest for people to look at. No activities took place on the first day of our visit, and people were reliant on the television or occupying themselves. On the second day of our visit the Activity Organiser had engaged a group of people in a game of Snakes and Ladders; they also told us that some people living at the home had been on a trip to Rutland Water, which all had enjoyed. They also told us that many people who had wanted to go were unable to do so as the transport provided could not accommodate people with mobility difficulties or who required the use of a wheelchair. We were told that the company organising the trip had assured the owner of Vishram Ghar that appropriate transportation would be provided. The Activity Organiser told us that they needed additional equipment to ensure that people had a wider range of activities of interest. We discussed this with the owner of Vishram Ghar who said money was available to purchase additional equipment. We noted that the Activity Organiser and an external organisation known as Learning of the Fourth Age, have spoken with people living at the home and gathered information about the persons lives prior to their moving into Vishram Ghar, which includes information about their childhood and education, married lives, children, and other lifetime experiences. The Activity Organiser has spoken with people and found out what individual activities and events they would like to achieve for themselves. We noted that the records of one person we looked at had requested that they visit a Temple. We found no evidence that this has been acted upon, the Activity Organiser said this was due to difficulties in getting accessible transport, the owner of the home told us that accessible taxis could be organised. This shows that communication between staff and owners of the home is not managed well and has a direct consequence on the quality of lives of people living at the home. We looked at records and found that people living at the home spend time with staff and the Activity Organiser talking about things which are important to them, such as their lives in their country of birth and their family. We were told that one person has planted flowers in the raised beds at the rear of the home by the patio, and that people have sat outside in the garden. Vishram Ghar DS0000063114.V376622.R01.S.doc Version 5.2 Page 18 We spoke with people living at the home and asked them how they spend their day, they told us:“I join in the exercise sessions in the home.” “I read by Holy Book.” “I like to knit.” “I like to watch the television.” The Activity Organiser works three days week, between the hours of 11am and 7pm, during this time they assist with personal care as well as providing activities. They told us that they would benefit from having additional support to enable them to engage people in activities more effectively and enable them to help people go out more frequently. Vishram Ghar offers people an Asian lifestyle home and provides Asian meals. All the meals are cooked at the home in one of two kitchens; non-vegetarian and vegetarian kitchen. We were told that only one person currently living at the home is not vegetarian and that this person is provided with a meal containing a non-vegetarian diet several times during the week. We found that the menu was displayed on the foyer and on the wall of the corridor outside of the dining room. The menu showed that the menu was reflective of a range of Asian foods from people’s country of origin. The menu included a range of vegetable curries and lentils, rice, chapatti/roti (flat bread) and service with pickle, salad and poppadoms. We asked people at the home if they liked the meals, they told us:“I enjoy the meals.” “I have as much to eat as I like.” People also told us that they attend Resident Meetings and discuss the meals provided; we read the minutes of these meetings which showed us that changes to the menu have taken place following people’s comments. We sat with people at lunchtime and participated in the meal, the meal was served to people individually, and they were asked what they wanted to eat. Everyone was offered additional servings. The lunchtime was relaxed and unhurried with music playing in the background. Vishram Ghar DS0000063114.V376622.R01.S.doc Version 5.2 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Vishram Ghar have access to a complaints procedure and are supported and cared for by staff who have received training and guidance in the promotion of people’s rights. EVIDENCE: We wanted to find out how the staff at Vishram Ghar promote the safety and welfare of people who live at the home. We spoke with the owner of the home and looked at the information provided within the self assessment tool completed by a representative of the service before we visited the home, the information provided told us that a copy of the complaints procedure has been given to everyone and that it is now available in English as well as Asian languages. Information we were given told us that the home has received five complaints, of which all were upheld and resolved within 28 days, we looked at the records and found that complaints had been recorded. In the last 12 months the Care Quality Commission has referred complaints to the Registered Person to investigate, and we have received a response as to their outcome. We are aware that people have raised one concern with Social Services, and a Vishram Ghar DS0000063114.V376622.R01.S.doc Version 5.2 Page 20 representative of Social Services visited the home, and whilst they noted some areas for improvement, the complaint could not be substantiated. When we asked people living at the home if they knew how to complain or whether they had any concerns, everyone told us that they had no concerns or complaints. The management and recording of complaints has improved since the previous key inspection, which identified shortfalls. Surveys we received from staff told us that they know what to do if someone wishes to make a complaint. We looked at the training records and found that all senior carers and carers have attended a course about the Mental Capacity Act, and senior staff have received training on Deprivation of Liberty Safeguards which is part of the same legislation, the training enables staff to understand how to support people living at Vishram Ghar by having a greater understanding as to how they need to enable people to maximise their rights and choices. Training records also show that a majority of staff received training in safeguarding adults last year, which enables staff to understand the types of abuse to which older people are at risk, and the responsibility and role of staff in reporting any concerns they have. Vishram Ghar DS0000063114.V376622.R01.S.doc Version 5.2 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Vishram Ghar are provided with an environment which is adequately decorated that would benefit from improvements to enhance the quality of life people living at the home receive. EVIDENCE: We had a tour of Vishram Ghar looking at communal areas including bathrooms and toilets, all areas of the home are decorated to a basic standard with a majority of rooms being painted a neutral colour, with some corridors having patterned wall paper. The décor of the home has not been done with consideration as to how colours and patterns affect the day to day lives of people with dementia, and this is an area for improvement. Vishram Ghar DS0000063114.V376622.R01.S.doc Version 5.2 Page 22 Woodwork in the home in many areas is damaged and requires painting. We did find that some areas of the home have been improved since the last key inspection, corridors in some areas have new flooring which is easy to keep clean and bedrooms in some areas of the home have been painted with a neutral colour and have had new carpets. Communal areas do benefit from cultural and religious ornaments, statues and pictures reflective of the needs of those living at the home. The owner of the home told us that they have responded to the Environmental Health Officers report which found shortfalls in the kitchen area in February 2009, and that they were anticipating a visit from them to ensure that the requirements they had issued have been carried out. We spent time in some people’s bedrooms talking to them about the care and support they receive, bedrooms are without en-suite facilities and have been personalise by the individual with personal mementos, pictures and ornaments. People were happy to speak to us about their family whose photographs were displayed in their room. There is a car park to the front of the home, and the front area has shrubs and plants, this area requires maintenance as the bushes have become overgrown, and there are a number of weeds growing in the footpath. The rear of the home has a courtyard with seating, looking over the school grounds, which is next to the home. Weeds are growing through the patio area, but attempts have been made to make the area more attractive with plants and flowers being planted in raised beds. The Activity Organiser told us that someone who lives at the home had done this as they enjoyed gardening. Vishram Ghar DS0000063114.V376622.R01.S.doc Version 5.2 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Vishram Ghar are supported and cared for by people who are able to communicate effectively with them and who have received training in health and safety topics, staffing numbers mean that the quality of life for some people is not as they would wish. EVIDENCE: We wanted to find out whether the number of staff and their care skills are able to meet the needs of people living at Vishram Ghar, we were told that throughout the day there is a senior carer on duty, who works alongside two to three care staff, with two staff working at night. Our observations were that staffing levels were able to meet the basic care needs of people living at the home. The staff rota detailed that the home employs two cooks and a domestic; however care staff are responsible for undertaking the laundry, which reduces the time they have to spend with people living at the home. On the day of our visit their were twenty three people staying at Vishram Ghar, should the number increase to forty, which is the number of people the home is registered to accommodate, their would need to be a significant increase in Vishram Ghar DS0000063114.V376622.R01.S.doc Version 5.2 Page 24 the number of staff working at the home at any one time. Surveys we received from staff working at the home gave mixed views as to whether the staffing levels at the home were able to meet the needs of people living at the home. One member of staff wrote:‘Staff levels are very low, if we have more than six people to one member of staff this affects the quality of care we give people.’ The level of care and support people receive is dependent upon the number of staff employed and the training they receive, if the service is to further develop to provide more individualised and tailored care through person centred care, as well as developing the range of activities and outings available to people, staffing levels will need to increase along with a flexible staff rota which will facilitate individual needs and choices. Discussions and records we looked at told us that individuals ability to access community resources and take part in activities is dependent upon the number of staff working at the home, one person had detailed within their care plan that they would like to visit a Temple this had not been acted upon due to staffing and transport issues. Whilst we noted that care needs were met, staff had little time to spend with people, engaging them in conversation, people at the home are reliant on the activity organiser to provide activities and events, and they work at the home three days a week. Information provided to us prior to our visit told us that 38 of staff has attained a National Vocation Qualification in Care. We looked at the training matrix and found that the level and range of training has improved, but additional training is still required. The training matrix evidenced that staff have received training in risk assessment, however when we looked at risk assessments completed, we saw the outcome of the assessment but no information as to how the decision was made and the criteria used to determine the decision. We looked at the recruitment records of some staff living at the home, all contained a completed application form, and written references along with a Criminal Record Bureau (CRB) disclosure, and this shows us that the recruitment process is robust and that people who work at the home have been checked to ensure their suitability to work with vulnerable people. Surveys which were returned by staff confirmed that checks were carried out before they commenced work at Vishram Ghar. Vishram Ghar DS0000063114.V376622.R01.S.doc Version 5.2 Page 25 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36 and 38. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management changes have effected the consistent day to day management of the home, and opportunities for staff to contribute and comment on the care provided to people is limited, this has impacted on the ability of the home to improve in a timelier manner. EVIDENCE: Vishram Ghar currently does not have a Manager and the home is being run on a day to day basis by one of the homes owners, the owner advised us that they had interviewed for the position of Manager and that they would be Vishram Ghar DS0000063114.V376622.R01.S.doc Version 5.2 Page 26 commencing their appointment at some point in August 2009. We advised that we would expect that the Manager appointed would submit an application to us, the ‘Care Quality Commission’ for the position of Registered Manager, in the near future. The Registered Person had until recently employed on a temporary basis the services of a management consultancy firm to support them to improve the care and support people at the home receive and review how the home is managed, which included looking at the paper work and day to day management issues. We noted that their have been some improvements to the day to day running of the home, however there are still areas which require improvement, with some requirements which were made at the previous inspection not being met or fully met. We the Care Quality Commission will continue to keep this under review. Improvements are needed to the quality of care people receive through the development of person centered care and development of comprehensive care plans. Consultation and communication with staff needs to be addressed so that staff have a good understanding as to how the home needs to improve as well as being offered the opportunity to make suggestions and comments to improve the quality of lives of people living at the home. The frequency and range of activities and recreational events people living at the home are able to participate in needs to be reviewed and increased by effective transport and flexibility in staffing. The environment decorated and furnished to a higher standard with consideration to the needs of people with dementia, staff training and involvement in the day to day running of the home and improvements to communication. We read the minutes of staff meetings, and found that minutes represent what the owner is saying, and included no comments as to the thoughts and views of staff working at the home, discussion with the owner identified that staff do not influence the agenda of meetings, and there was no evidence to suggest that the home has a policy of developing an open and inclusive atmosphere. We spoke with people living at the home and they told us that they attend resident meetings to which family and friends are also invited, people told us that in the main issues discussed are acted upon, minutes of meetings are taken and are sent to people’s relatives and friends. Staff need to be aware of what residents and their families are discussing, and this could be facilitated by issues being discussed at staff meetings. We looked at the financial records of two people whose records we had viewed, to ensure that the ‘spending money’ of those individuals which is managed by Vishram Ghar DS0000063114.V376622.R01.S.doc Version 5.2 Page 27 the home is managed well. We found records detailing expenditures and the money recorded as being on site was accurate to the money available. We spoke with staff who said that they receive a one to one supervision from the owner of the home, the frequency of these supervisions varied. The owner showed us a record of supervisions, but acknowledges that due to annual leave and sickness the time between supervisions varied. Through discussion we found that staff do not contribute to the agenda of supervisions, and that the content is decided by the supervisor (owner of the home). Surveys we received from staff gave mixed views as the support provided by the managerial team. Information provided within the self assessment tool which we received prior to our site visit showed that equipment is maintained, which includes electrical and gas systems, the passenger lift, along with fire detection systems. On our visit we noted fire extinguishers along with fire and emergency lighting system were being serviced by a contractor. Vishram Ghar DS0000063114.V376622.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 2 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 1 3 X 3 2 X 3 Vishram Ghar DS0000063114.V376622.R01.S.doc Version 5.2 Page 29 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 OP7 Regulation 15(1) (2) Requirement Care plans must be comprehensive, reflecting all aspects of care, including information provided in the social workers assessment, the safety measures identified from risk assessments, giving staff clear guidance and provides information as to how the person wished their care to be carried out and their preferred daily routines. This would ensure care needs can be met safely, risks minimised and staff promote people’s health, safety and wellbeing. By failing to do so you are in breach of Regulation 15, which is an offence under the Care Homes Regulations 2001. This is an outstanding requirement. 2. OP7 15(1) (2) Care plans must be kept under review and updated, when changes have been identified DS0000063114.V376622.R01.S.doc Timescale for action 30/11/09 30/11/09 Vishram Ghar Version 5.2 Page 30 and in consultation with the person and their relatives. This would ensure changing care needs are known and care be met safely. By failing to do so you are in breach of Regulation 15, which is an offence under the Care Homes Regulations 2001. This is an outstanding requirement. 3. OP8 12, 13 Staff must receive training to meet people’s assessed needs. This includes: • Pressure area care to be able to monitor, identify and take action to prevent pressure sores developing; 30/11/09 This would ensure people are protected by trained staff that follow best practice to promote health and safety. By failing to do so, you are in breach of Regulation 12 and 13, which is an offence under the Care Homes Regulations 2001. This is an outstanding requirement. 5. OP8 13(4) Care plans to be supported by 30/11/09 comprehensive risk assessments which include the criteria for how the risk was determined as well as the action needed to be taken to reduce the risk. To prevent and reduce risk to people living at the home. Vishram Ghar DS0000063114.V376622.R01.S.doc Version 5.2 Page 31 4. OP9 13(2) By failing to do so, you are in breach of Regulation 13, which is an offence under the Care Homes Regulations 2001 All medicines kept at the home for service users must be accurately accounted for. Systems must be in place to be able to carry out complete audit trails for medicines. This is to safeguard the health and wellbeing of people who live at the home. By failing to do so, you are in breach of Regulation 13, which is an offence under the Care Homes Regulations 2001 30/11/09 5. OP9 13(2) When people are designated as being able to handle their own medication, this must be carried out within a risk- managed framework. This is to safeguard the health and wellbeing of people who live at the home. By failing to do so, you are in breach of Regulation 13, which is an offence under the Care Homes Regulations 2001 30/11/09 6. OP9 13(2) All medicines that require to be kept in cold storage must be stored in an appropriate fridge where the temperature range is maintained between 2-8’C. 30/11/09 7 OP27 18(1) By failing to do so, you are in breach of Regulation 13, which is an offence under the Care Homes Regulations 2001 Staffing levels to be continually 30/11/09 reviewed in the home to meet the changing needs and numbers DS0000063114.V376622.R01.S.doc Version 5.2 Page 32 Vishram Ghar of people living at the home, with evidence kept of the reviewing process. To ensure that the needs of people living at the home are met. By failing to do so, you are in breach of Regulation 18, which is an offence under the Care Homes Regulations 2001 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 OP3 Good Practice Recommendations The Registered Person obtains an up to date assessment from a Social Worker, prior to an individual being admitted in to the home, when the individual is referred by a Social Services department. Care plans include how individual choices and request for accessing activities and community resources are to be met and facilitated. The staff that deal with medication should have their competency assessed on a regular basis. These reassessments should be documented on the staffs training files. The Controlled Drugs Cabinet should be securely fixed to the wall. The management at the home should carry out frequent documented audits checks on the medication record sheets and stock levels. Additional staffing, resources and equipment are provided to enable people living at the home to take part in a wider range of activities and interests with greater frequency. Transport is organised which enables people living at the DS0000063114.V376622.R01.S.doc Version 5.2 Page 33 2. 2. OP7 OP9 3. 4. OP9 OP9 5. 6. OP12 OP13 Vishram Ghar 7. 8. OP19 OP32 home to access the community and take part in activities of their choosing. The home to be decorated and furnished in a manner which promotes the health and well-being of people with dementia. Consultation and involvement of staff who work in the home is encouraged and valued to improve the quality of lives of people living at the home. Vishram Ghar DS0000063114.V376622.R01.S.doc Version 5.2 Page 34 Care Quality Commission East Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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