CARE HOMES FOR OLDER PEOPLE
Vishram Ghar 120 Armadale Drive Netherhall Leicester LE5 1HF Lead Inspector
Keith Williamson Unannounced Inspection 29th February 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.V358920.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.V358920.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.V358920.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 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.V358920.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 1 star. This means the people who use this service experience adequate quality outcomes.
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 three residents were chosen. Staff were also spoken with, and an interpreter was used to assist the inspector. A specialist inspector was used to assess the pharmacy and medication processes. 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 plan. What the service does well:
The Responsible Individual provides an Asian style environment, which meets the needs of the majority of the current resident group. The privacy and dignity of residents is good with residents spoken with indicating so. Activities are provided for the majority of residents in the home. The resident and relative meetings have good outcomes for residents with a positive effect on meal choices offered. Food is good with an appropriate diet offered to the residents in the home. Visiting is unrestricted in the home. The physical improvements to the building have greatly enhanced the environment for residents in the home, these are almost completed now. There is an ongoing plan for future improvements. Staff have a good recollection of each residents individual care requirements. Residents returning for their second or subsequent respite (or short stay) breaks are having their needs re-assessed, and a new plan of care produced. Vishram Ghar DS0000063114.V358920.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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.V358920.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.V358920.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 good This judgement has been made using available evidence including a visit to this service. The Statement of Purpose is now more detailed resulting in accurate information on which to base the residents’ stay.Detailed assessment information is also in place to ensure residents care needs can be met. EVIDENCE: Of the residents’ files that were viewed on this occasion, all had a contract or statement of terms and conditions in place. These were signed by the resident or a representative. Assessment information for the residents was viewed. The information gathered by the staff has increased in detail, and was adequate from which a plan of care could be developed. One resident had details from a previous
Vishram Ghar DS0000063114.V358920.R01.S.doc Version 5.2 Page 9 stay, also held on file. Any changes in the person’s condition were noted to make staff aware of the amended needs. The home does not provide facilities for intermediate care. Vishram Ghar DS0000063114.V358920.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. Care planning has improved, with a broader range of subjects covered in the plan, however more detail could be added to the plans and risk assesments. This would raise the safety levels in the home. Medication records are up to date and there are accurate records of medicines received, administered and disposed of. EVIDENCE: Care plans and risk assessments have improved with all three care plans being detailed enough to assist staff in the care of the resident. One resident had a plan form a previous stay, and though the areas covered were similar, a new plan had been written for this visit. Risk assesments were adequate to cover the needs of the resident concerned, though a greater attention to detail could further improve this area.
Vishram Ghar DS0000063114.V358920.R01.S.doc Version 5.2 Page 11 Health care monitoring is in place with a number of issues being covered including nutrition and diet, weight, foot and oral care. Staff when spoken with showed an excellent knowledge of the residents care needs. Medication administration records (MAR) were generally complete. Handwritten records were not always dated and signed by the person writing them but the information was found to be correct and clear. There were good records to show accurate audit trails of most medication received, carried over from the previous month, administered and destroyed. However the administration records for prescribed creams and ointments carried out by care assistants were not signed by the person administering them. Information about prescribed medication for a new resident had only been obtained from a relative. It was not clear whether one medicine should still be in use and the resident’s GP had not been contacted to confirm what was currently prescribed. Care plans lacked detail to inform staff how to give medication correctly for example when only needed occasionally. However care staff spoken with were found to be knowledgeable about medicines for individual residents. A GP visited regularly every week and records were kept of each resident seen. New medication policies and procedures were in place but they did not cover all areas of medicine management. They did not cover administration, storage and ordering. The manager explained that they were in the process of writing a new medication policy with the help of the community pharmacist. Medication storage areas were spacious, clean and tidy. Security and storage temperatures were appropriate except that the controlled drug cupboard had not been re-hung on the wall after decorating. The manager said that this would be dealt with later on the day of the visit. Senior staff spoken with were not clear of the appropriate legal requirements and good practice recommendation for the storage and recording of controlled drugs. The privacy and dignity of residents’ is good with one resident commenting how staff ensure toilet doors are closed, and confirming that staff usually knock before entering a bedroom. Generally residents are happy with the levels of care and commented “the staff are very kind and friendly” and the manager “is very kind, like a member of the family”. Vishram Ghar DS0000063114.V358920.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 adequate This judgement has been made using available evidence including a visit to this service. Improvements to the quality of information gathered in the assessment process, and the employment of an activities person has resulted in a better level of activities in the home. EVIDENCE: There is an improvement in the level of social care information available in the home. There is a greater degree of information being gathered at the point of assessment, though entries in care plans could have more detail for staff. An activities person has been employed and shall be formulating activities specifically for residents suffering with Dementia. There is still limited menu information available for the residents in the home, other than on the notice board. Menus continue to be compiled following the regular residents’ and relatives meetings. Comments from residents included “the food is good here, I’m happy”.
Vishram Ghar DS0000063114.V358920.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 adequate This judgement has been made using available evidence including a visit to this service. Residents’ are better protected by an improving awareness by staff to complaints and adult protection policies and practices. EVIDENCE: There have been no complaints forwarded to the Commission for Social Care Inspection since the last visit to the home. The complaints policy and procedure have now been amended, and these are available in the foyer of the home. The complaints records were viewed with no further complaints being recorded since the last visit. Staff showed an improved awareness of complaints, whistleblowing and adult protection strategies. Residents spoken with indicated they were happy to speak to staff regarding any worries they had. The manager indicated that she intends to raise the profile of protection issues with the staff on an individual basis. Vishram Ghar DS0000063114.V358920.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. 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.V358920.R01.S.doc Version 5.2 Page 15 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 adequate This judgement has been made using available evidence including a visit to this service. Improving standards in the recruitment process, staff numbers and planned training, show a commitment toward protecting people 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, and would commence employment the week following the visit. A consultant has also been employed to oversee development of the home, and assist the manager. The manager stated the proposed hours of work shall allow a variety of social care tasks with individual residents and small groups. Staff files viewed had the required security checks in place prior to staff commencing work. The Responsible Individual explained how the recently completed staff training programme had been compiled. New training programmes for the incoming year shall start following the one to one meetings with staff, arranged by the manager.
Vishram Ghar DS0000063114.V358920.R01.S.doc Version 5.2 Page 16 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 adequate This judgement has been made using available evidence including a visit to this service. The management approach does not yet promote effective quality assurance practice in the home. EVIDENCE: The position of establishing quality assurance within the home has improved, with the recent residents meeting establishing feedback from residents regarding staff attitudes and levels of willingness to assist. Quality assurance questionnaires have yet to be distributed to residents and their relatives, and the outcomes added to the Service User Guide.
Vishram Ghar DS0000063114.V358920.R01.S.doc Version 5.2 Page 17 Staff supervision is still at the planning stage, and the manager was open about how these sessions would work, and what would be discussed with staff. It is not yet clear how the new consultant fits in to the management structure for supervision purposes. 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.V358920.R01.S.doc Version 5.2 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 X 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X X 3 X 3 Vishram Ghar DS0000063114.V358920.R01.S.doc Version 5.2 Page 19 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 5 (1 & 2) Requirement Timescale for action 25/04/08 2. OP9 3. OP12 The Service User Guide must include the outcomes of any quality assurance exercise. This is to ensure the current resident group can affect the running of the home, and prospective residents to the home have full information on this. 13 (2) Medication administration records should be kept for all prescribed medication including creams and ointments, which should be signed by the person administering them. This is to ensure that medication is administered according to the prescribers’ instructions. 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 and 31/12/07 remains unmet).
DS0000063114.V358920.R01.S.doc 29/03/08 25/04/08 Vishram Ghar Version 5.2 Page 20 4. OP30 18 (1) c,i A staff training programme must be produced for the staff in the home. This is to ensure all staff have the upto date skills to care for residents in the home. 25/04/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations The policy and procedures for medication should be reviewed with the help of a pharmacist to ensure that they cover all areas of medication management and that they reflect current good practice guidance and recommendations from the RPSGB and CSCI. This is to ensure that all medication is managed safely and correctly and according to good practice guidance and legal requirements. Information about medication in risk assessments and care plans should be reviewed to ensure that residents receive medication correctly. 2. OP9 Vishram Ghar DS0000063114.V358920.R01.S.doc Version 5.2 Page 21 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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