Inspection on 06/06/07 for Wisma Mulia

This inspection was carried out on 6th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Wisma Mulia 11/10/07

Wisma Mulia 12/06/06

Wisma Mulia 24/02/06

Wisma Mulia 08/08/05

Wisma Mulia 18/01/05

Wisma Mulia 20/07/04

Wisma Mulia 18/02/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Wisma Mulia Bridge Road Frampton-on-severn Glos GL2 7HE Lead Inspector Mrs Janet Griffiths Unannounced Inspection 6th June 2007 09.35 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 Wisma Mulia DS0000016654.V335039.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. Wisma Mulia DS0000016654.V335039.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Wisma Mulia Address Bridge Road Frampton-on-severn Glos GL2 7HE 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) 01452 740432 01452 740084 Fountain Housing Association Limited Mr Philip L James Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25), Sensory impairment (5) of places Wisma Mulia DS0000016654.V335039.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th June 2006 Brief Description of the Service: Wisma Mulia is a care home situated in the village of Frampton-on-Severn. The secluded gardens surrounding the home give both peace and privacy to the service users who live there. The core philosophy of the home is based on a spiritual following called Subud. This is an association of people of all races, religion and creeds. Its foundation is the simple worship of God without dogma or teaching. This does not preclude anyone from living there. The extension to the main house comprises of single flatlets and double flatlets on the ground and first floor served by a shaft lift. The ground floor flatlets have French doors and paved patio areas. The main house has six single, ground and first floor bedrooms. There is also a separate coach house. Communal areas on the ground floor consist of a lounge, dining room, solarium and a spacious room used for prayers and activities. The gardens are well kept and include a fountain and seating area. Information about the service to include CSCI reports is made available by the provider to prospective service users through the homes’ Statement of Purpose and Service Users Guide. At the time of inspection the fees are between £365 and £490 per week. Additional charges are made for hairdressing, chiropody and newspapers. People funded through the Local Authority have a financial assessment carried out in accordance with fair access to Care Services procedures. Local Authority or Primary Care Trust charges are determined by individual need and circumstances. General information about fees and fair terms can be accessed from the Office of fair trading web site at www.oft.govuk http:/www.oft.gov.uk Wisma Mulia DS0000016654.V335039.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. This unannounced key inspection site visit took place over nine hours on two days in June 2007. During the site visit the inspector spoke to a number of residents, staff working in the home and the manager of the home. A tour of the premises took place. Some of the bedrooms/flatlets and the communal areas were seen during the course of the two days. Seven resident’s files were examined in detail to include their medication records. Other records examined included staff personnel and training files, the quality assurance file and accident records. Surveys were sent to service users prior to the inspection and the results were collated and fed-back at the end of the inspection. A pre inspection questionnaire was sent out several weeks before the inspection and returned to CSCI. Information from this was used when completing the site visit and writing the report. On another day the pharmacy inspector carried out an inspection of the medication administration processes. The reason for this inspection was for a pharmacist inspector to carry out a specialist inspection of the arrangements for handling medication (National Minimum Standard 9 Care Homes for Older People) as part of the key inspection. This included looking at some stocks and storage arrangements for medicines, some medicine record charts, some other medication records, the medicine policy and procedures. Some rooms were visited and the procedure for administering some medicines was observed. There were discussions with the manager and three members of staff. Two people who live in the home were spoken with. The inspection took place over 5½ hours on a Thursday. What the service does well: Wisma Mulia DS0000016654.V335039.R01.S.doc Version 5.2 Page 6 The home offers a calm, peaceful and homely environment in which to live and all of the service users spoken with said how contented they were living at Wisma Mulia and what a good quality of life they had. The home aims to maintain the independence of the residents for as long as they are able and the provision of a number of flats where the resident has their own kitchenette contributes to this. The relative of one resident commented that the staff have looked after his mother magnificently, far beyond anything he could have expected. They love her and give her the best possible quality of life. This is a superb care home. Another said the carers are very good but they were not quite so satisfied with the food. What has improved since the last inspection? What they could do better: There are still some serious issues with medications detailed in the report that need to be addressed. Some areas of concern were found which needed urgent action to comply with the regulations and safeguard people who use this service. At the end of the inspection an immediate requirement form was left and the manager was told about the things that he needed to take action on. These were all confirmed in a letter we sent on 15th June 2007. Wisma Mulia DS0000016654.V335039.R01.S.doc Version 5.2 Page 7 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. Wisma Mulia DS0000016654.V335039.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 Wisma Mulia DS0000016654.V335039.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 and 3. Standard 6 not applicable. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents and their families have all the information they need to make an informed choice regarding placement at the home. Pre-admission visits take place and needs are assessed by the manager and senior carers prior to and following admission. Residents are not admitted for intermediate care therefore Std. 6 was not assessed Wisma Mulia DS0000016654.V335039.R01.S.doc Version 5.2 Page 10 EVIDENCE: The home has a comprehensive Statement of Purpose, and Service Users Guide, a copy of which is given to each resident/ their relatives on admission. This is reviewed regularly and any changes made. The last review took place in November 2006, when minor changes were made. From surveys received, all of the residents/their relatives confirmed they had been given enough information about the home prior to admission and several confirmed that they had visited the home/knew of the home before admission. The manager or senior care staff always sees each prospective resident and complete an assessment. This ensures that the home would be able to meet their needs. Examples of these pre admission assessments were seen. Most surveys and those residents spoken with confirmed that their needs are met and that they receive the care and support they need. Comments from the surveys also confirmed that they had received a contract, which the home refers to as a ‘licence agreement’ and again copies of these were seen on file. Wisma Mulia DS0000016654.V335039.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Although people who live at the home have most of their health care needs met through the systems in place, there continues to be significant failures in the arrangements for the management of medicines, which do not protect their health and well-being Those living in the home are treated with respect; their privacy and dignity are protected. EVIDENCE: Seven care files were examined to include those of residents admitted since the last inspection. Wisma Mulia DS0000016654.V335039.R01.S.doc Version 5.2 Page 12 The two senior care staff have completely reviewed all the care planning system over the last year and a very good system is now in place. All records clearly identified individual care needs and how these should be met, and most of the care plans reflected the current needs of these residents. The exceptions to these were where two residents needs have changed recently; one needs a review to update their care plan and another has an identified problem, being at risk of pressure sores, and is having appropriate treatment following referral to the district nurse, but this is not documented in a care plan. It was also noted that one problem identified was ‘dementia’. This is not specifying what the problem is or what care is required by the staff and needs to be addressed. The key workers regularly reviewed all of the care plans with the resident and/or relatives where possible. Staff spoken with demonstrated that they were fully aware of all of the resident’s needs and how they could meet them. They are kept informed on a day- to -day basis through thorough handovers, care plans and daily records. Residents spoken with and surveys received confirmed that they received the care and support they needed. Residents spoken with, and the care records examined, confirmed referral to and intervention from health professionals where necessary. Dr’s visit as required and where possible residents visit the surgery, which is close to the home. The district nurses are currently visiting several residents. Records also confirmed that residents receive visits from the chiropodist and the continence adviser among others, and were taken out to other appointments such as for hearing tests or to visit the optician. There was evidence of intervention when someone had been assessed as at risk of pressure sores and the district nursing services had provided the relevant pressure relieving aids. A hoist has also been provided where mobility was becoming a problem. Moving and handling and risk assessments are completed for each resident and reviewed monthly. During the pharmacist inspection some areas of concern were found which needed urgent action to comply with the regulations and safeguard people who use this service. At the end of the inspection an immediate requirement form was left and the manager was told about the things that he needed to take action on. These were all confirmed in a letter we sent on 15th June 2007. Wisma Mulia DS0000016654.V335039.R01.S.doc Version 5.2 Page 13 One of the people who live in the home was having the wrong medication and this was subsequently found as due to a mistake in the dispensing of the correct item from the supplying surgery. All the records of this person related to medications indicate one particular medicine. The surgery label was for the correct tablets according to the records but the blister of tablets in the box was for a different product. An immediate requirement form was left at the inspection to determine from the doctor the correct medication for this person and make arrangements to give the correct medication by 1700 on 15 June 2007. The manager confirmed in a telephone call that this action was taken and that the surgery had accepted responsibility. Even so if carers notice a difference in tablets from those previously used they should raise this so that appropriate checks can be made; the name on the actual blister can be confirmed as correct with the surgery or reference book such as the British National Formulary. For the same person audit checks of two medicines could not account for all the tablets or capsules. Records did not clearly indicate how many tablets had been given for one of these. On 13th June 07 the medicine chart was marked X for two prescribed capsules as staff said there was none in stock so the dose was missed. There was additional stock in the medicine cupboard, which had been there for a few days and staff were not aware of. The prescription directions allow variable doses of these two medicines but there was nothing in the care plans to guide staff as to how to use them for the benefit of that person. Some eye drops for another person dispensed on 12th June 2007 were stored at room temperature in the medicine cupboard rather than in the fridge between 2 – 8°C as the manufacturer states. This can lead to degradation of the product and reduced effectiveness if it is not stored correctly. The medicine chart for another person indicated 5ml of a liquid medicine was given daily. The strength of the liquid is not defined on the chart (there are at least two different strengths available). The bottle of medicine being used was 1mg in 1ml strength and was labelled 0.5 to 1.0ml twice daily. Nothing was found in the records to confirm the correct dose and explain why this was given differently from the label on the container, which is a copy of the doctor’s directions and therefore the authorisation to administer. We received a letter from the manager on 21st June 2007 with information about the action taken on these matters, There is a medicine policy and procedures so that staff are aware of how the home expects medicines to be managed. Staff who administer medicines have undertaken training in the safe handling of medicines organised by a local college. The manager was only able to show us the training certificate for one member of staff. In addition to the training course a regular assessment of staff competence for safe practice with handling and administering medication Wisma Mulia DS0000016654.V335039.R01.S.doc Version 5.2 Page 14 is needed. Evidence from this inspection indicates staff do not fully understand about correct management of medicines. There are records of medicines received, administered and disposed of to make sure there is no mishandling but there were a number of issues noted needing attention: • A medicine dose was written as ‘mg’ (milligrams) instead of micrograms. • The strengths of some medicines were not included on some medicine record charts so it is not clear what dose is given. • Information to properly define a medicine such as ‘enteric coated’ was missing from another record. • Records do no show the dose administered when a variable dose is prescribed (10-20ml for example). • There were gaps in some medicine recording charts for May 2007 so it is not known if the medicines were given or missed. • Records for two people who had antibiotics prescribed recently indicated that these had not been given according to the prescribed directions. This could mean the treatment would be less effective. • One person prescribed a medicine to give by placing between the lip and the gum was given a measure of water for her tablet and there appeared to be confusion over the way the medicine is given which could mean the treatment would be less effective. • There are standard codes printed on the medicine charts to use when medication is not given. ‘X’ is sometimes used but is not a defined code. • No information is written in the box for allergies or drugs not to be given. This should be completed even if this is ‘none known’ as an indication that this important point has been considered. A liquid medicine for another person is put in a drink. Staff said this person knows they do this as she sees them make the drink. The care plan notes that staff administer medicines but there was nothing about giving medication in this way. A protocol describing that this is agreed in the best interests of this person is needed. For the same person there is another medicine prescribed to use ‘as required’ although no doses have been given. There is no plan to describe to staff how to use the medicine. Some people living in the home are able to look after their own medicines following a risk assessment. A lockable space must be provided so that people can keep their own medicines in a way that is safe for everybody in the home. Staff said that the flats are kept locked when people are not there but the front door to one flat where medicines are kept was open but nobody was in the flat. Some records do not accurately say when medicines are given to people in the home to look after and take themselves and what medicines are in the control of the home. Some medication was still in the medicine cupboard although the records would indicate as given to that person. Some records indicate ‘self administer’ although staff are signing as administering. Wisma Mulia DS0000016654.V335039.R01.S.doc Version 5.2 Page 15 The reason for giving medicines is noted on medicine records but there were examples where the information was wrong so staff do not understand the broad use of some of the medicines. There was no up to date medicine reference book in the home to help with this. One lady was spoken to who said that the staff and doctor are very good and staff always call the doctor if needed. This person has painkillers but the directions on the medicine label were different to the records and there was no plan about pain or medication use. Locked storage areas are provided for medicines. The cupboard in the staff room was mounted above a radiator so the medicines sometimes may be stored at too high a temperature, which can make them less effective. The location of one cupboard in the area under the stairs is very difficult to use. Medicines that are applied externally need to be kept segregated from those that are swallowed to reduce the risk from cross contamination. Some items in an unlocked first aid cupboard in a bathroom were out of date and other items should be in the proper medicine cupboard. A senior carer said she would stop using this cupboard at once and dispose of the contents. On the first day of the inspection a controlled medication was not stored or recorded in accordance with accepted best practice and the lead inspector had drawn the manager’s attention to this. At the pharmacist inspection a week later some action had been taken but the controlled medicine cupboard section needs to be properly secured to a solid wall with rag or rawl bolts and the key must be kept with the medicine keys rather than on top of the cupboard. Information was provided about using a better record book rather than a notebook. Medicines are supplied from the local surgery so the home does not have the benefit of receiving regular advice from a pharmacist. This point could be brought to the attention of the PCT to see if some pharmacist advice can be arranged to assist the home. Residents spoken with and observations showed residents being addressed respectfully, and staff knocking on doors before entering rooms. Wisma Mulia DS0000016654.V335039.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home caters for a wide range of individuals who are supported to realise their own preferences and expectations, both in the home and in the community. Maintaining contact with friends and family is supported by the home. Residents receive a wholesome, appealing and balanced diet in pleasant and comfortable surroundings. EVIDENCE: A weekly programme of activities is planned and a notice displayed in the sunlounge area, for residents to note and to take part if they wish. Wisma Mulia DS0000016654.V335039.R01.S.doc Version 5.2 Page 17 Facilities provided include an art room, an in-house shop, a Latihan hall (used for Subud meetings among other things) and a home cinema. Activities and social events include shopping trips, excursions such as boat trips and visits to see snowdrops/bluebells etc, summer picnics, barbecues, village coffee mornings and visits by musical groups, talks and Subud members. A mobile library provides a good supply of reading materials and the hairdresser visits each week. Several residents spoken with confirmed their enjoyment of the barbecues, film shows, and shopping trips especially. Of the surveys received, three stated that they always take part in the activities arranged, eight said they usually did and one relative stated that although their mother is frail and often bed bound staff include her in every activity they can. One resident related how pleased she was that the local village community are invited into the home on social occasions and how friendships have been formed. One member of the community now takes her to church. From observations during the visit it appeared that residents if they wish have quite an active social life and continue to live their lives much as they would in their own homes, wherever possible. One resident who has recently moved to different accommodation is busy planning the patio area outside her flatlet and has purchased a number of plants etc. for this purpose. Several others spoke of their exercise they take daily walking either to the canal bridge or the village green, both within a short distance. Visitors are made welcome at any time of the day or evening and beverages are offered. Most residents also have facilities for tea/coffee making in their rooms if they wish and their visitors may join them for meals having made prior arrangements with the kitchen. Where necessary visitors can also be offered accommodation if they wish or need to stay overnight. As a result of comments from residents at their meetings and past survey results, arrangements were made for a consultant to review the menus and develop new ones with the catering staff. Copies of these have been provided and most comments about the changes of menus were quite favourable. Survey results stated that two always enjoy the food in the home, five usually do and four sometimes do. One stated ‘Big changes- wonderful’ and another ‘Recently the menus have changed and I haven’t been able to eat the food’. A choice of light breakfast such as cereals, porridge, toast, fruit and fruit juices are available each morning in the residents’ rooms. Those who are able may prepare their own in their kitchenettes. Coffee is also served in their rooms and flasks are available, then lunch is served at 1 pm. Wisma Mulia DS0000016654.V335039.R01.S.doc Version 5.2 Page 18 Most people eat in the dining room, but they may stay in their rooms if they wish. Supper is a buffet style meal that can be eaten in the dining room or a choice collected and taken to their rooms. Meals served on both days of the inspection looked and smelt very appetising. Special dietary needs are catered for and supplements are provided when intake is poor. Wisma Mulia DS0000016654.V335039.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Systems within the home protect the interests of residents. EVIDENCE: The home has a complaints procedure included in the service users guide, provided with the contract and on display in the home. All but one of the surveys received confirmed that they would know how to complain but no one has, to date. Comments received were: ‘I don’t like making complaints’. ‘Day- to- day problems-yes. More serious complaints – unsure (but thinks would see Mr James)’. The manager is always accessible when on duty and as observed he has a constant stream of residents visiting the office to discuss matters with him. Wisma Mulia DS0000016654.V335039.R01.S.doc Version 5.2 Page 20 The Commission has received two anonymous calls earlier in the year related to concerns both with care of residents and staffing issues. The Provider was asked to investigate these and most issues were unfounded. The Commission was satisfied with their investigation and subsequent action taken such as review and change of policies within the home. These concerns were raised again after the investigation and during the inspection these issues were again looked at and discussed but the inspector could find little evidence to suggest any grounds for these concerns, other than those related to medications. The home has policies and procedures in place, which includes policies on adult protection and prevention of abuse, which was reviewed in October 2006. Staff have also received Protection of Vulnerable Adult training over the last year Wisma Mulia DS0000016654.V335039.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home is well maintained, clean and hygienic throughout. Equipment is provided to aid mobility and promote independence. Individual bedrooms are decorated and equipped to meet the needs of their occupants. EVIDENCE: The inspector visited some rooms and flatlets when speaking to residents and also saw all the communal areas in the home. The home appeared to be clean, and well maintained. Wisma Mulia DS0000016654.V335039.R01.S.doc Version 5.2 Page 22 The dining carpet is quite badly stained but had already been noted as requiring change. The kitchen has been refurbished with new units since the last inspection but one overhead cupboard door was hanging off. It was reported and had been repaired by the second day of inspection. The kitchen is due for redecoration shortly. A number of items of equipment such as a new freezer have already been purchased. Also since the last inspection 3 flatlets and one en site room in the main house have been renovated, the office and Latihan hall and main entrance have been redecorated and the coach house is in progress. A home cinema has been added in Latihan Hall. Individual bedrooms seen, reflected the interests and needs of their occupants. Some residents had brought in favourite items of their furniture such as a chair or bed and there were lots of photographs, pictures and ornaments in most of the rooms seen. However the needs of those who preferred minimal decoration was also respected. Most of the residents spoken with felt the home was cleaned well, although some still enjoyed doing some of their own cleaning and bed changing etc. From the surveys received, seven said the home was always fresh and clean and four said it usually was. Wisma Mulia DS0000016654.V335039.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29, & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has sufficient staff who are skilled to meet the needs of those living at the home. Service users are protected by the homes recruitment system. Staff are supported to undertake regular and relevant training. EVIDENCE: There were three staff on-duty during the morning and two/three on the late shift, as well as the manager on throughout the second day. In addition to care staff there was a cook, a kitchen assistant, a laundry assistant, a cleaner, a maintenance man and the administrator on-duty There was a calm unhurried atmosphere in the home and no one appeared to be under pressure and no residents were observed calling or waiting for attention. Wisma Mulia DS0000016654.V335039.R01.S.doc Version 5.2 Page 24 Seven surveys stated that staff were always available when needed, four said usually and one said sometimes and one commented that the home has been short staffed at times. With increased dependency of residents the rotas need to be constantly reviewed and staffing adjusted according to the needs of the residents. Three staff files were examined of staff appointed since the last inspection. All had applications completed and all the records and checks required. All gave a full career history, although some was not put in chronological order as requested, and also provided a curriculum vitae (CV). All also had confirmation of mental and physical fitness. All had documents of identification but two did not yet have a photograph on file. All had two written references, one from the last employer but in one instance not one from the last health care employer as required. All staff have had Criminal Record Bureau (CRB) and Protection of Vulnerable Adults (POVA) checks and all of these were seen. The manager was advised that once seen by CSCI these can be shredded in accordance with Data Protection. An interview checklist was seen but a record of interviews was not clearly recorded in some instances. Staff training records confirmed that they undertake regular training and updates, the most recent being moving and handling, food hygiene, POVA, health and safety and administration of medication. The two senior carers attended a care- planning workshop. Further first aid, moving and handling, health and safety, fire training is planned, moving and handling scheduled for 20th and 29th June. Copies of some certificates were seen, but nothing was seen related to medication in the files seen. Staff induction checklists are also in place but although staff receive a full induction programme, practical skills are learnt through shadowing experienced staff and the induction programme is not yet fully recorded in line with Skills for Care. The inspector was also concerned that a new member of staff appointed in January has not yet received moving and handling training. This is to be addressed immediately. Thirteen staff have NVQ level 2 or above, which is equivalent to 72 . Wisma Mulia DS0000016654.V335039.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32, 33,35, 36,37 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Overall, the home is well run by the manager whose approach is open and inclusive and in the best interests of those living here. However, the systems in place to protect both residents and staff have failed with regards to medication administration. Wisma Mulia DS0000016654.V335039.R01.S.doc Version 5.2 Page 26 EVIDENCE: The manager is a qualified social worker with experience of running and owning care homes in the recent past and has almost completed NVQ 4 registered managers award. All of the residents spoken with were very satisfied with the way he manages the home and his willingness to do all he can to provide a good quality of life for everyone living there. He operates an open door policy, which was observed during the inspection. Staff spoken with all said that the manager is very supportive and they feel confident to discuss anything with him although some felt he takes on too much and is ‘stretched’ too much, so that he finds it difficult to achieve everything he aims to do. The home does have formal meetings on occasions although it is sometimes difficult to get all the staff together but he meets regularly with the senior carers, and is present at daily handovers and makes every effort to see the night staff regularly. The last staff meeting was held on 12.10.06. Resident meetings are also held, the last being three weeks ago and the manager also attends the weekly coffee mornings. All but one of the residents surveyed felt that staff listen to and act on that they say and all of those spoken with were very confident that they could get the support/assistance they required from the manager. Daily records are now being kept and these are full and informative and demonstrate action taken when a problem has been identified. Accident records are kept and audited and it was reported in the pre-inspection questionnaire that there had been two accidents resulting in admission to accident and emergency and three deaths since the last inspection. The Commission has been notified of these, but the manager was reminded that all other events such as the lift breaking down, or a drug error must also be reported immediately. Satisfaction surveys are carried out by the home regularly, the last being in February 2006. These were distributed to residents, relatives/representatives and stakeholders such as doctors, district nurses, the local undertaker and the chiropodist. These results were collated and a report completed and provided to the inspector. The survey distribution is about to be carried out for this year. Wisma Mulia DS0000016654.V335039.R01.S.doc Version 5.2 Page 27 In addition to this the manager carries out a number of other audits to include care plan, medication, accident, nutrition and kitchen audits and mandatory and specialist training. However, from the pharmacy inspection findings it would appear that the medication audit has not been effective in identifying problems within the system and must become much more vigilant in the future. Residents finances are generally their own or their families responsibility and the home does not act as appointee to any resident. Staff confirmed that they received annual appraisals and supervision, although there was a little confusion over what they had actually had. A schedule for supervision was seen but is not totally up to date although the manager said he meets staff regularly he does not always make a record of these meetings. Some supervision/appraisal records were seen to support this. Records were also seen to confirm that regular maintenance and servicing of equipment is carried out, to include legionnaires water testing, lift and hoist servicing. Fire equipment s also serviced regularly and fire alarms and emergency lighting tested regularly. Staff also receive fire training, which records confirmed. Environmental health visited a week before the inspection and made recommendations about fridge and freezer temperatures. They will be returning after the kitchen has been redecorated. Wisma Mulia DS0000016654.V335039.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 3 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 4 13 4 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 2 3 2 Wisma Mulia DS0000016654.V335039.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 OP9 Regulation 13(2) Timescale for action For one identified person living in 06/07 the home, determine from the doctor the correct medication and make arrangements to give the correct medication. (Immediate requirement form left at inspection on 14th June 2007). Investigate and account for the 06/07 medication identified at the inspection as possibly missing. (Included in letter for urgent action sent on 15th June 2007). For another identified person 06/07 living in the home determine from the doctor the correct liquid medication dose and make arrangements to administer the correct dose in accordance with the doctor’s directions. (Included in letter for urgent action sent on 15th June 2007). Store the eye drops identified at 06/07 the inspection at the correct temperature as identified by the manufacturer. (Included in letter for urgent action sent on 15th June 2007). 07/07 DS0000016654.V335039.R01.S.doc Version 5.2 Page 30 Requirement 2 OP9 13(2) 3 OP9 13(2) 4 OP9 13(2) Wisma Mulia 5 OP9 13(2) 6 OP9 13(2) 7 OP9 18 8. OP30 18(1)(c) 9. OP36 18(2) When medication is administered to people living in the home it must be clearly and accurately recorded and given according to the doctors’ directions with routine audit checks in place to confirm this. There must be up to date documented information for each person (where applicable) to clearly describe how to use any medication prescribed for use ‘as required’ or as a variable dose. This is to make sure that people receive the correct levels of medication. view the storage arrangements for 07/07 medicines to make sure that they are always kept below 25°C (or between 2 to 8°C for medicines needing refrigeration) and all medicine cupboard keys are kept securely. When medication is kept in bedrooms, lockable storage must be provided and the arrangements must be checked as being safe for all people living in the home. en staff are involved with the 08/07 handling and administration of medication they must be properly trained and regularly assessed as being competent to perform these tasks safely. The registered person must 31/08/07 ensure that all newly appointed staff received structured induction training, to include mandatory training such as moving and handling and fire training. Persons employed in the home 31/08/07 must be appropriately supervised and a record kept of this supervision. Wisma Mulia DS0000016654.V335039.R01.S.doc Version 5.2 Page 31 10 OP38 37 Ensure that any accident/incident to include a medication error, is reported to the Commission without delay. 31/07/07 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 2 Refer to Standard OP9 OP9 Good Practice Recommendations Provide access to an up to date authoritative medicine reference so that staff have reliable information about medicines they use. Fix the controlled medicine cupboard so that it is secured in accordance with The Misuse of Drugs (Safe Custody) Regulations 1973. Provide a properly printed and bound record book to keep records when these medicines are used. All new members of staff should receive induction training to Skills for Care specification. Care staff should receive formal supervision at least 6 times a year. 3 4 OP30 OP36 Wisma Mulia DS0000016654.V335039.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Gloucester Area Office 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester. GL3 4AB 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 © 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 Wisma Mulia DS0000016654.V335039.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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