Inspection on 26/10/08 for Westport Care Centre

This inspection was carried out on 26th October 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 22 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Westport Care Centre 01/06/07

Westport Care Centre 03/05/06

Westport Care Centre 22/12/05

Westport Care Centre 15/08/05

Westport Care Centre 11/01/05

Westport Care Centre 15/09/04

Westport Care Centre 06/02/04

Westport Care Centre 25/09/03

Westport Care Centre 14/07/03

Westport Care Centre 30/05/02

Extracts from inspection reports are licensed from CQC, this page was updated on 30/01/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Westport Care Centre 24-26 Westport Street Stepney London E1 0RA     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Anne Chamberlain     Date: 2 7 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 35 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 35 Information about the care home Name of care home: Address: Westport Care Centre 24-26 Westport Street Stepney London E1 0RA 02077901222 02074239701 susan.lawlor@excelcareholdings.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Ferrolake Ltd care home 44 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 44 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 within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE Date of last inspection Brief description of the care home Westport Care Centre is a registered residential care home which caters for 40 older people of both gender who require care and support. It also offers respite services dependant on the availability of beds. The premises are a purpose built four-storied building. All bedrooms have en-suite toilet and shower facilities. A range of communal areas including a smoking room and a patio garden are available. Parking spaces are available underneath the building. The home is conveniently situated close to public transport links and other local amenities. The Registered Provider is Ferrolake Ltd. The fees are between #511.56 and 527.80 weekly. Care Homes for Older People Page 4 of 35 Over 65 0 44 44 0 Care Homes for Older People Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection followed a random inspection which was carried out on 1st June 2008. It was unannounced and was of key standards, the requirements made at the previous random and key inspections. The report is written on behalf of the Commission for Social Care Inspection and the terms we and us will be used throughout. An inspection was carried out by the London Borough of Tower Hamlets in February 2008 and we have drawn on this for our inspection and report. Prior to the site visit surveys were sent to residents , staff and health professionals by us. We received twelve completed surveys back from residents, three from staff and one from a health Care Homes for Older People Page 6 of 35 professional. The results of the surveys have been integrated into the report. The inspection was conducted on two days over some nine and a half hours. We spoke with service users, relatives and staff and were assisted by the manager of the service. We viewed the case files of four residents and looked at the arrangements for the administration of their medication. We toured the building and looked at key documentation including information provided by the manager in e-mail format. We would like to take this opportunity to thank the residents, staff and manager of the service for their assistance and co-operation with the inspection. What the care home does well: What has improved since the last inspection? What they could do better: 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 set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 35 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users receive good quality in this outcome but the manager needs to consider whether she has sufficient staff to meet their needs when accepting residents who have dementia. Evidence: The home has admitted a number of new residents over recent months and the proportion of people who are suffering from dementia has increased to 33 (13 out of 39). The manager stated that when assessing new referrals she ensures that she gets comprehensive assessment information. She said that if the referred person cannot communicate with her and the next of kin is not available she consults hospital notes or social work reports. The manager said that she also considers compatibility issues because she does not want to disrupt the wellbeing of existing residents. We were satisfied that the manager is undertaking good quality assessments of Care Homes for Older People Page 10 of 35 Evidence: prospective residents. The home currently has a resident who is having respite care. This individual was admitted in an emergency. The home is supporting the individual to maintain her independence. Care Homes for Older People Page 11 of 35 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users experience adequate quality in this outcome area. The shortfalls in care planning, risk assessment and administration of medication undermine practice. Evidence: We viewed four residents files. They all had service user care plans and these were all individualised to their needs. However we were not satisfied that all needs were covered in care plans. One resident has behavioural problems which were not documented and another resident had a problem with limitation of hand movement which was not recorded. Also there was a lack of evidence of the updating of care plans. An example would be for resident no 1. We noted the last update was in February 2008. Also the resident had a pressure sore in September 2007 As a result a Braden scale assessment (a tool for assessing vulnerability to pressure sores) which was completed in December 2007. A pressure sore plan stated that the Braden scale should be updated every month. The Braden scale had not been updated since December 2007. The nutritional screen had last been done in December 2007 when Care Homes for Older People Page 12 of 35 Evidence: the individual scored 13. A score of 7 or above equals high risk. The manager stated that the individual has not had any new pressure sores so her care plan obviously needs to be updated to show the changed needs. The file showed no weights recorded for this individual since July 2008. The manager stated that the recording of weights is kept separately. As many of the residents at the home have complex needs and factors monitored interrelate, we would recommend that all information relating to an individuals health monitoring be kept together in their file. For this individual there were no afterlife wishes recorded and no resuscitation information. The above individual was admitted with a history of multiple falls and has had a number of falls at the home including a fall on 5/10/08 when she sustained a head injury. The recording of this is sparse with no explanation of how the fall happened. The residents file showed no input from the falls clinic. Risk assessment dated 29/2/08 identified psychiatric risk due to dementia but showed nothing on how to reduce the risks. General risk assessment for an individual identified a risk of falling but had not been updated since 29/2/08 although the individual has had a number of falls since that time. In the file of resident no 2 a risk assessment dated 22/1/08 for people handling simply said that she had had no falls, the rest was blank. In her notes in July the Podiatrist said that the resident had reported a fall to her in July and the manager said that she herself had observed a graze on this ladys leg. The risk assessment had not been updated. Another risk assess dated 28/6/08 which appeared to be a general risk assessment for the individual had no safeguards recorded. On the file of resident no 3 it is stated that his skin needs careful monitoring. However the Braden scale for this individual was last undertaken in 10/3/07. The people handling risk assessment was last updated in 22.1.08 There was a risk assessment for falls but it lists no actions to take to reduce risks. There is a people handling risk assessment last updated 22/1/08 and a moving and handling assessment (which would seem to assess the same risks) with no date or signature. Resident number 4 had an Initial Assessment document where the word Initial had simply been crossed out and the word Re inserted - presumably an attempt to turn it into a reassessment without updating it. This individual demonstrates inappropriate Care Homes for Older People Page 13 of 35 Evidence: behaviour at times but the assessment does not document this need. There was a recording of a recent episode of behaviour where the resident had touched a staff member inappropriately. There was no antecedent behaviour consequence (ABC) chart completed and no information as to how the situation had been dealt with or how the parties would be supported. There was no risk assessment on file for the inappropriate behaviour of this resident and how it should be managed. The general risk assessment had not been updated since 3/2/06. The risk assessment for mobility was last updated in 27/3/06 and states that the resident uses walking sticks. The resident actually walks with a Zimmer frame. Across the four files inspected there were examples of poor care planning and risk assessment with a lack of information and a lack of updating of information. We noted on one file a list of dates of updating with no action required written alongside, but found these rather unconvincing. The date of updating no action required in one case preceeded the rewriting of this assessment by three days. One resident had difficulty with her hearing aids not working properly. We received a complaint on her behalf from relatives visiting someone else. The hearing aid problem was reported to the manager who has responded promptly. However it transpires that the resident is wearing the wrong hearing aid and has an ear infection. It is disappointing that this work was not undertaken before. The resident has been at the home since September. She said she had reported her hearing aid problems to staff but nothing had been done. Files held information regarding the input of professionals on contact sheets. These demonstrated that residents see a range of professionals including chiropodists and podiatrists. The manager stated that she calls on the palliative care team when she needs their specialist input. She referred to mattresses which had been provided through the district nursing service and we saw an example in a ripple mattress. The manager stated that an optician calls. However we remain concerned that the falls clinic for one resident and the physiotherapist for another were not accessed. We inspected the arrangements for the administration of medication, auditing Medication Administration and Recording (MAR) sheets and stocks of medication for the four residents we were case-tracking. Most of the medications administered in the home are from monitored dosage system (bubble) packs but some medications are loose. Care Homes for Older People Page 14 of 35 Evidence: For resident no 1 we found no discrepancies. For resident no 2 that there were two tablets left at a time in the cycle where there should have only been one. These were in a bubble pack. This indicates that a tablet was signed for as given but actually was not given. The second resident had her name recorded on the lists of residents on both of the two trolleys which the home uses. Her medication is dispensed from only one and we recommend that her name is taken off the other one. For resident no 3 there was a gap in the MAR chart on 25th of this month. For resident no 4 there were gaps in the boxes for 24th and 25th of this month. There were also entries which were impossible to decode, they could have been initials or A for refused or just a scribble. It was therefore impossible to attempt to balance the stock of this medication. The manager investigated the medication errors following the inspection. In the case of resident 4 she uncovered a genuine reason why the resident was reluctant to take his medication at night (because it gives him a very dry mouth). The timing of the medication has therefore been changed. We are concerned however that this change has taken place following an inspection and had not been addressed before. The manager stated that she had had some difficulties with the pharmacy supplying medication in inaccurate numbers and incomplete information on MAR charts. We reminded the manager that it is her responsibility to ensure that the medication received into the home is complete and accurate including the MAR charts, before it is administered to residents. As a result of the inspection the manager has drafted a daily audit of medications form. Relatives spoke highly of staff and said that their attitude was generally excellent. The interactions we observed between staff and residents was respectful and staff we spoke to appeared person centred in their approach to residents. Care Homes for Older People Page 15 of 35 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Social contact and activities in the home are not a strength and meals and mealtimes are not fully satisfactory to residents. Evidence: The London Borough of Tower Hamlets (LBTH) survey in February stated that few residents expressed satisfaction with the amount and quality of activities offered in the home. We have received a complaint from a family that there is little in the way of activities being organised in the home. The home does arrange group outings occasionally. However a resident complained that she could not go out as often as she would like to. She said that carers had offered to get the items for her if she gave them a list, but she would like to go shopping herself. A resident said in a survey Would like to go out more, shop for clothes, go to the park and socialize more outside. The home retains a carer who has a dual role, carer a.m. and activities co-ordinator. She is assisted by a carer who has no designated activities co-ordinator hours, but who has attended the same training. We talked with the assistant activities coCare Homes for Older People Page 16 of 35 Evidence: ordinator at some length. There are two lounges at the home. She said that she had been able to play a parachute game that morning for about twenty-five minutes with some of the residents on one lounge. She had not been able to start until nearly lunch time so had not been able to play the game in the other lounge. We asked about people being escorted out. She said that more could be done but that it comes down to if you have got the staff on duty. She said that with the normal staffing ratio it would not be safe to leave the home, and this restricts being able to go out with people. She said that an additional staff member in the mornings would make it possible for people to go out a lot more. The manager stated that there are 25 dedicated activity co-ordinator hours. In a document entitled Supporting information re Dementia Variation Westport Care Centre the manager states the following: Activities 15 OP and 15 DE per week From this we understand that 30 hours of supported activity were projected for 10 dementia residents and 30 old people. This is less than is being provided now for 13 people who have a formal diagnosis of dementia and 26 old people. We told the manager that the social needs of residents must be recorded in their care plans and she must request senior management to increase levels of staff to meet these needs, including going out. A requirement was made at the last key inspection that a resident who wanted to go out must have this need documented and addressed. It seems that residents social need to go out is still not adequately addressed. There is a level of community participation. One resident had recently attended a club after a long break (her choice) and she had had a really nice time and would go again. Service users are encouraged to bring their personal possessions to the home. However one resident said that all her personal things went into store when she came into the home some time ago. The manager agreed to raise this at a social services review which is due to happen soon. Another resident had nothing of her own in her room except minimal clothing. The manager agreed to contact this persons social worker to find her own personal effects or to buy some new things. We are concerned that these two actions are occurring following an inspection rather than being addressed in a timely manner. Care Homes for Older People Page 17 of 35 Evidence: In the LBTH survey, some negative comments were made about food provided and there was a quote on Sunday evenings there is no cooked meal, just a sandwich. We received a complaint recently from a relative about food. The complaint was that the food produced and the menu differed, that a four week plan is posted in the lounges but that staff do not know what week they are on and that supper was the worst meal, Sundays being particularly poor. Also that there is not a choice between brown and white bread and that the menus is always the same, soup and sandwiches and sometimes there is no pudding although it is on the menu. Accordingly we started our unannounced inspection of the home on a Sunday afternoon. We went downstairs to the kitchen to speak with the cook. A temporary cook was preparing the supper. He was wearing a very dirty apron. He showed us the list of foods he had had been left to prepare. The supper was soup, sausage rolls, sandwiches and angel delight. The sandwiches had a variety of fillings and some of them had been made with brown bread. Later the manager produced evidence that she has increased the order of brown bread. There was evidence that a cooked breakfast had been provided in the morning and that a cooked lunch had also been provided in line with the menu for the day. The food temperatures over the previous period evidenced a good variety of foods. Relatives also said that lunch is always good. The refrigerator temperatures had been recorded up until 24/10/08 but the temporary cook had not taken the refrigerator temperatures for the day of the inspection and the day before, although the forms had been left out for him to do this. He said he had overlooked them. On the second day of the inspection we noted that jacket potatoes had been provided as well as the soup and sandwiches. The manager showed us evidence that the cultural dietary needs of one resident had been addressed. He had ticked which meals on the general menu he accepted and for the meals he did not want a substitute caribbean meal would be provided by the homes catering supplier. The food in the home appears to be adequate but we feel that the supper menu could be expanded to include more variety as this seems to have been a theme from service users and relatives. A recommendation has been made. Care Homes for Older People Page 18 of 35 Evidence: We observed one resident eating his meal in his chair in his room (which was his choice) balancing his plate on his lap with no tray or table. A requirement has been made that all residents who need tables for eating in their rooms have them. On observing supper being served we notes that the two tea pots being used had no knobs on the lids. This presents a risk of scalding and any tea pots which are not complete must be replaced with new ones. We also observed a lunch being served. There was no salt or pepper on the tables and one resident told us he wanted to season his meal. We noted that the salt and pepper shakers were dirty, also one salt dispenser (i.e. with one hole) was filled with pepper. Care Homes for Older People Page 19 of 35 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users experience good quality in this outcome area, but there are some outstanding issues regarding medical emergencies. Evidence: As detailed above we have received some complaints recently about the home. The manager showed us how she records complaints and we reviewed two which she had dealt with during 2008. The process for addressing complaints is satisfactory. Complaints are acknowledged quckly and a full response is provided in a timely manner. At the last key inspection we viewed the organisations policy for the protection of vulnerable adults which was quite satisfactory. The manager stated that this had not changed. A safeguarding alert was made recently and CSCI were fully involved, undertaking a random inspection and attending safeguarding meetings. Requirements were made at this random inspection which were assessed at this inspection. The safeguarding referral and investigation was brought to a satisfactory conclusion but a decision was taken at the safeguarding meeting that staff attend a training session at the home regarding emergency medical situations. This is still to be provided by the LBTH safeguarding team. Care Homes for Older People Page 20 of 35 Evidence: Care Homes for Older People Page 21 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users experience adequate quality in this outcome area. The overall good standard of the home is undermined by the presence of offensive odours in specific areas. Evidence: We undertook a tour of the premises. The home is safe and comfortable, but we felt it was too hot. London Borough of Tower Hamlets, on their monitoring visit of February 12 2008 pointed this out and in the subsequent action plan the manager said that repairs would be done to the heating system during warm weather as it would have to be turned off for several days. A requirement has been made. Some redecorating has been done and generally the home looks clean and fresh. There is a need to replace a carpet in a residents bedroom, which is very worn by his bed. As mentioned above two residents are lacking their own possessions and the manager is expected to address this. Generally rooms were personalised. A requirement was made at a previous inspection that the thin mattresses found then be replaced with deeper mattresses for residents who wanted them. We found that a number of residents were still sleeping on thin mattresses. We asked them if they would prefer a deeper mattress and most of them said they would. A requirement has Care Homes for Older People Page 22 of 35 Evidence: been made. The home was generally clean and the laundry arrangements seemed to work well. We asked one resident if she is happy with the way her clothes are laundered and she said she was. The floor finishes in the home are not impermeable except in some individual rooms where linoleum has been laid. The toilets and corridors are all tiled. The home has a major problem with the offensive odour of urine, which was present in certain areas on both visits, despite those areas being washed. One vacant bedroom on the third floor smelt strongly of urine. We have made a requirement. We viewed the staff room which is in the basement. The ceiling tiles had been removed in one part on the ceiling and these must be replaced. Care Homes for Older People Page 23 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this 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 staff situation in the home is mixed. The staff in place work well but they are stretched and have not had the training and supervision expected. Evidence: Relatives told us they thought the staff at the home were very good but that there were not enough of them. The evidence from our inspection of activities is that the programme is affected by the availability of staff. In a survey a resident listed the home could do better with enough staff. A staff survey stated but it would be good for there to be more staff as this would be effective in giving more care to clients. Another said I feel that with more staff the home could achieve more. The home has increasingly admitted service users who have dementia. At the last key inspection on 1/6/07 we stated that there were 31 residents and six staff on shift. We made a requirement that should the number of residents in the home increase staffing levels must be reviewed. We feel that the staffing level has not been increased sufficiently to reflect this. In a document entitled Supporting information re Dementia Variation Westport Care Care Homes for Older People Page 24 of 35 Evidence: Centre the manager gives the following table: Phase 2 Up to 10 DE (dementia) and 30 OP (old people) 2 SHCA 5 HCA 0800-1400 2SHCA 4.5 HCA 1400 - 2000 SHCA = senior health care assistant HCA = health care assistant The manager stated that as supervison is not yet fully in place appraisal is not happening either. A restated requirement has been made. We looked at the training records of two staff. They had had a substantial amount of relevant training including First aid, the senior undertaking a four day course and the carer a one day course.The manager stated that seniors are attending the four day First Aid course and care workers are attending the one day course. However the manager stated that at the time of the inspection not all workers had undertaken their training. The requirement has therefore been restated. Care Homes for Older People Page 25 of 35 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the home is good, safety and quality assurance are addressed but staff supervision is lacking. Evidence: The manager is competent to run the home. However she has had severe difficulties with the constant breakdown of the lift during the summer months and staff shortages. The manager stated that a quality assurance form is completed every week and also every month by a manager. The organisation surveys the residents once a year, residents meetings are held every two months and records of these were seen. We asked the manager to describe the procedure for the safekeeping of residents monies. The process appeared secure and we we viewed paperwork and receipts. Residents sign for cash and receipts are kept for purchases made for them by staff. We are satisfied that residents monies are kept safe. The manager stated that the Care Homes for Older People Page 26 of 35 Evidence: regularlity of supervision is not yet up to the requirement standard. We checked the supervision record for two staff, one had had group supervision twice during the year and one to one once. The other had had supervision twice this year. As the year is now ten months old, the supervision rate is below the six times per year which is required. The manager stated the following safety checks had been undertaken. Fire Drills 9th February 2008 Day Staff 19th August 2008 Night Staff Alarm Tests are carried out Weekly 15.7.08, Zone 3, 22.7.08 Zone 5, 25.7.08 Zone 6, 1.8.08 Zone 7, 7.8.08 Zone 8, 14.8.08 Zone 9, 21.8.08 Zone 10, 29.8.08, Zone 11, 5.9.08, Zone 12, 12.9.08, Zone1, 19.9.08 Zone 2, 1.10.08, Zone 3 10.10.08, Zone 4 17.10.08 Zone 5 27.10.08 Zone 6. Outside contractor Tests were carried out as follows: PAT Test 26.9.08 Monthly Water Service Record Oct 2008 Fire Inspection Service Certificate 16.6.08 Emergency Lighting Lolar 25.4.08 Fixed Wiring 6.6.05 Gas Safety 20.8.08 Fire Fighting Equipment 7.8.08 Monthly Emergency Lighting carried out Oct 08 Annual Routine Electrical Check June 2008 Extractor Cleaning Routine 6 Monthly 26.6.08 Light Fitment Cleaning Regime Records 6 Monthly August 4th 2008 Care Homes for Older People Page 27 of 35 Evidence: Nurse Call Monthly Oct 08 Electrical Insectocutors Monthly Oct 2008 Drugs Trolley Condition Report Monthly - October 08 Window Restrictors Log October 08 Care Homes for Older People Page 28 of 35 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action 1 8 15 Details of instruction 01/09/2008 regarding resuscitation must be easily available for emergency situations. 2 8 14 (4) (c) All carers must be trained in first aid. 01/10/2008 3 11 15 The residents wishes 01/09/2008 concerning arrangements after death are discussed and carried including whether or not they wish to have the Last Rites performed by a priest. Care Homes for Older People Page 29 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 13 Risk assessments must be completed to reflect needs. To ensure the welfare of residents 01/01/2009 2 7 13 Risk assessments must be 01/12/2008 updated every six months or when needs change. To reduce risks to residents. 3 7 15 The manager must ensure that all needs are recorded in the care plan. To ensure the welfare of residents. 01/01/2009 4 7 15 Care plans must be updated at least every six months and whenever needs change. To ensure the welfare of residents 01/01/2009 5 8 15 Details of instruction 01/01/2009 regarding resuscitation must be easily available for emergency situations. RESTATED REQUIREMENT Page 30 of 35 Care Homes for Older People To ensure resident choice. 6 9 13 The registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. For the safety and wellbeing of residents. 7 11 15 Residents wishes concerning 01/01/2009 arrangements after death must be discussed and carried out including whether or not they wish to have the Last Rites performed by a priest. RESTATED REQUIREMENT To ensure resident choice. 8 11 12 The registered manager 01/12/2008 must ensure that carers do not take decisions on whether or not life is extinct. To ensure the safety of residents. 9 12 1 Food must be prepared in a hygienic manner, and the cook must not wear a dirty apron. For the hygienic preparation of food. 10 12 1 Residents must not have to balance plates on their laps, tables must be provided. For the safety and comfort of residents. 01/11/2009 01/12/2008 01/12/2008 Care Homes for Older People Page 31 of 35 11 12 1 The manager must ensure 01/01/2009 that there is an adequate programme of activities to meet the needs of residents. To meet the social needs of residents. 12 12 1 The manager must ensure that residents have opportunites to access the community regularly. To ensure community participation. 01/12/2008 13 15 1 Tea pots must be complete with knobs on the lids. For health and safety. 01/12/2008 14 15 1 Salt and pepper pots must be clean and filled with the correct seasoning. For hygiene and to avoid confusion. 20/11/2008 15 19 23 The missing ceiling tiles in the staff room must be replaced. For safety and comfort of those using the room. 01/01/2009 16 24 16 The manager must replace the carpet in room no 37. For the safety and comfort of the service user. 01/01/2009 17 24 1 The manager must provide 01/01/2009 thicker mattresses for everyone except those using speacialised mattresses or those who specifically do not want to change their mattress. Care Homes for Older People Page 32 of 35 To ensure the comfort of residents. 18 25 1 The manager must ensure that that the temperature in the home is comfortable. So that it is not too hot for service users or staff. 19 26 23 The manager must do all she can to eliminate unpleasant odours from the home. For the comfort and wellbeing of service users and staff. 20 30 19 All staff must be trained in first aid. RESTATED REQUIREMENT To ensure the safety of service users. 21 30 18 The manager must discuss with her senior managers the level of staffing in the home. To ensure the safety of service users. 22 36 18 The manager must ensure that staff receive formal supervision six times per year. So that they are able to do their jobs adequately. 01/01/2009 01/12/2008 01/12/2008 01/01/2009 01/01/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 33 of 35 1 2 3 8 9 12 All the information regarding residents should be recorded in their files. Residents information should only appear on one medication trolley. The manager should try to improve on the variety of the supper menu, as this is the expressed wish of the residents and their relatives. Care Homes for Older People Page 34 of 35 Helpline: 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 We want people to be able to access this information. 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