Inspection on 12/06/07 for Worcester Intermediate Care Unit

This inspection was carried out on 12th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Worcester Intermediate Care Unit 18/11/08

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Maple Lodge

Heathlands

Aston Court Nursing Home

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Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Worcester Intermediate Care Unit 229 London Road Worcester Worcestershire WR5 2JG Lead Inspector Sandra J Bromige Unannounced Inspection 12th June 2007 09:15 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 Worcester Intermediate Care Unit DS0000067999.V354406.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. Worcester Intermediate Care Unit DS0000067999.V354406.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Worcester Intermediate Care Unit Address 229 London Road Worcester Worcestershire WR5 2JG 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) 01905 767117 01905 767449 www.shaw.co.uk Shaw Healthcare (Group) Limited Mrs Susan Robertson Perry Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20), Physical disability (20), Physical disability of places over 65 years of age (20) Worcester Intermediate Care Unit DS0000067999.V354406.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd February 2006 Brief Description of the Service: Worcester Intermediate Care Unit is a nurse led 20 bedded specialist facility providing nursing care, physiotherapy and occupational therapy and is covered by Worcester City General Practitioners. The unit is located in a residential area on the outskirts of the city centre, within easy reach of the local amenities, shops and public services. Opened in 2001, the unit is contained within a dedicated area of Red Hill Court Nursing Home. Accommodation for residents is in single bedrooms with access to communal rooms. Care arrangements can be used to facilitate earlier discharge from hospital following an acute episode of illness; alternatively, it can provide care to prevent admission to hospital for people who have a short term episode of ill health, which does not require specialist medical intervention. All admissions have a time-limited stay, maximum being six weeks. Please refer to the home’s statement of purpose & service user guide regarding the funding arrangements and additional charges. Worcester Intermediate Care Unit DS0000067999.V354406.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place over one day by an Inspector and a Pharmacist Inspector. This was a key inspection – this is an inspection where we look at a wide range of areas. To help us plan the inspection we looked at pre-inspection information in the form of an Annual Quality Assurance Assessment requested from the service and completed by them some weeks earlier, survey forms received from relatives (two) and general practitioners (two). During the visit to the home care records, staff records and other records and documents were inspected. There was a tour of parts of the accommodation and interviews with staff, including the manager and other senior staff. Time was spent speaking privately with residents in their rooms as well as spending time out and about in the home observing what was happening and talking to residents and their relatives. We have not received any complaints about this service since the last inspection. What the service does well: The service provides information for prospective residents and this is on display in the unit. Prospective residents are assessed prior to admission to make sure that they are able to meet their care needs. The staff have a good knowledge of the care needs of the residents. Written comment from a relative stated the ‘support and care are good’ and a general practitioner wrote ‘always very high standard of care’. Staff respect the privacy and dignity of residents at all times and they are able to meet with their friends and family in the privacy of their room. Residents are able to make choices about their lifestyle. A varied menu is provided and residents have a choice of meals for lunch and supper. Specialist diets are catered for. Residents and their relatives have access to a robust complaints procedure and residents knew who they would speak to if they had any concerns. A survey completed by a relative stated ‘if I have wished to comment on any aspect of care I have done so to the manager and any comment has been well received and dealt with appropriately’. Staff received training about safeguarding people and about the local procedures for reporting safeguarding allegations. Staff spoken with were very clear about the action they would take if they suspected any inappropriate treatment of a resident. The service provides single en-suite rooms that are bright, clean, and tidy and the furnishings are of a good quality. The home is well maintained to ensure Worcester Intermediate Care Unit DS0000067999.V354406.R01.S.doc Version 5.2 Page 6 the safety of the residents and staff. Good systems are in place including staff training for the management of infection control. There are enough staff to provide the care, they receive training and are competent in carrying out their designated roles. The procedures for recruiting staff are robust to ensure that people are protected from harm. The unit is managed by a well-trained and competent manager. She has managed this unit since it opened in 2001, which has provided stability for the service. They seek, listen and act upon the views of residents who use the service. What has improved since the last inspection? What they could do better: Care plans need to be improved to make sure they have sufficient detail to enable staff to understand and meet the health and care needs of residents. The home need to make sure they have a system in place to ensure medication is available to administer as prescribed by the general practitioner. They need to record the amount of medication administered to the resident on the medication administration record. A system should be introduced to demonstrate that medication is stored at a safe temperature, below 25°C to ensure that residents are protected from harm. Handwritten medication administration records need to be double checked and signed by a second member of staff to agree the medication details recorded are correct. All residents’ allergy status need to be written on the medication administration records and oxygen storage warning signs need to be clearly displayed wherever oxygen is located to ensure the safety of the residents. Worcester Intermediate Care Unit DS0000067999.V354406.R01.S.doc Version 5.2 Page 7 The service need to see all prescriptions so they can check the medication order and have sight of the only document signed by the general practitioner in order to ensure the handwritten medicine charts are correct. 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. Worcester Intermediate Care Unit DS0000067999.V354406.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 Worcester Intermediate Care Unit DS0000067999.V354406.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): 3&6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are assessed and referred solely for intermediate care to enable them to maximise their independence and return home. EVIDENCE: The home’s Statement of Purpose and Service User Guide is on display in the home. A survey completed by a relative stated ‘we have not received any information in advance’ about the care home. Residents are assessed prior to admission by a trained health care professional who works for the Primary Care Trust. A recently admitted resident was case tracked. Information was seen in the care records and from discussion with the resident to show that all facilities had been provided including physio and occupational therapy for the post operative care of this resident. The resident told the Inspector, ‘I can’t fault them at all’. Worcester Intermediate Care Unit DS0000067999.V354406.R01.S.doc Version 5.2 Page 10 All residents are admitted to this unit for rehabilitation. The Annual Quality Assurance Assessment completed by the service confirms that 90 of residents are able to return home with support within a 6-week stay. Worcester Intermediate Care Unit DS0000067999.V354406.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 adequate. This judgement has been made using available evidence including a visit to this service. In the main residents benefit from good care outcomes, although the poor quality of the supporting care records has the potential to place the residents at risk of harm. Improvement is needed to the way the home manages medication records and procedures, and staff require further training in respect of these areas to ensure that medication is managed safely in the home and residents are not placed at risk of harm. Residents’ privacy and dignity is being maintained at all times. EVIDENCE: Three residents were case tracked and their care records were looked at in detail and we discussed their care with them. There is information in the care records of health care treatment and intervention and daily records giving general health care information. There are some gaps in the information whereby there are no plans of care showing the action needed by the staff or the care plans have not been reviewed. Staff spoken with were able to think in a person centred way and had a good knowledge of the care needs of the Worcester Intermediate Care Unit DS0000067999.V354406.R01.S.doc Version 5.2 Page 12 residents’ and were able to give a verbal update. It was evident from discussion with the residents’ the outcomes of care were good for the residents’ case tracked, although the poor quality of the supporting care plans has the potential to place the residents’ at risk of harm. For example, a resident had been admitted 10 days ago and had a history of falls. The risk assessment for falls, and moving and handling was not completed. A nutritional risk assessment had not been done. The resident was admitted with a pressure sore, the action plan for the pressure sore said to ‘apply an appropriate dressing’, but it did not specify the type of dressing and how often it needed to be changed. There were no photographs or measurements of this wound to enable staff to assess the progress or decline of the wound. The resident also had a night care plan but no further care plans were in place. A resident had been admitted the day before the inspection. There were no risk assessments other than a Waterlow and nutritional risk assessment and the care plan summary and no care plans were written. A resident had been in the unit since December 2006. The moving & handling risk assessment had not been reviewed since 1st January 2007 and the nutritional risk assessment had not been reviewed since the 3rd March 2007. The resident was diabetic, and the care plan for diabetes had not been reviewed since 16th January 2007. There was evidence to show that their blood sugar levels were being monitored as prescribed and the information for staff about how to deal with low blood sugar levels was very good. The falls care plan was reviewed on 5th February 2007 and stated ‘remains at risk of falls’. There was no review since that date. The falls risk assessment was reviewed on the 17th March 2007 and the resident was ‘moderate risk’, there was no review since that date. The resident had a care plan for ulcers to the left foot which was evaluated on the 7th June 2007 and stated a date for the next review of 9th June 2007. There was no written information to show that this had been done. The last entry in the care plan for the use of the wheelchair footplate was 22nd February 2007 and the risk assessment had not been reviewed since the 19th January 2007. The Annual Quality Assurance Assessment completed by the manager prior to the inspection identifies they are not always completing the paperwork within 72 hours of admission and states they are hoping to increase the staffing establishment to enable paperwork to be done within accepted timescales. Written comments from relatives about the care stated the ‘support & care are good’. The unit ‘care for its patients and prepare them for life outside’. Written information from general practitioners’ and healthcare professionals confirm they unit has a ‘patient centre approach’; they ‘always strive to be patient centred and to support both patients and their carers/partners/family’. ‘Sensitive to how patients & families are feeling’. The unit ‘has a very high standard of care’. There is ‘multi-disciplinary working’, with ‘holistic care’, and ‘excellent discharge planning’. Worcester Intermediate Care Unit DS0000067999.V354406.R01.S.doc Version 5.2 Page 13 The pharmacist inspector spoke to the manager and a team leader who were both very helpful. A medicine policy was available and accessible to staff, which included information on the receipt, administration and disposal of residents medication. In addition to this there was also a specific medicine procedure for the unit, which included details for the assessment of residents on admission to assess, whether they were able to self medicate. The service admits residents from a variety of places, for example direct from hospital. Medication is usually brought in with the resident, however when further medication supplies are required the service contacts the General Practitioner (GP) for a new prescription. The service does not always see the prescriptions written by the GP and are therefore not able to check the order before it is sent to the pharmacy. Residents’ medication was seen stored within individual locked cupboards in their own bedrooms. This allows residents independence if they wished to look after their own medication following risk assessment. One resident said ‘I do normally look after my own medication at home but I am happy for the nurses to help me whilst I am here. They are very kind’. The person in charge looked after the medicine keys. Clear and well-documented risk assessments were available for selfmedication. Three care plans seen clearly reflected that a comprehensive assessment had been undertaken to check whether a resident was safe to look after their own medication or if the nurses needed to assist them in medication administration. A copy of the risk assessment was also kept with the resident’s medicine chart, which was good practice. The inspection was undertaken on a warm day, however there was some concern about the correct storage temperatures for medication, which was discussed with the manager. Some medication requires careful temperature storage particularly during the hot summer months to ensure it is safe to administer. For example, medication requiring cold storage was stored within a refrigerator in a lounge area and although there was a daily record of temperatures available, the temperatures recorded were below the correct storage range for medication (2-8°C) and there was no maximum or minimum temperatures recorded. Some medication was stored within a locked storeroom, which felt very warm. The temperature of the storeroom was not monitored or recorded to ensure that medication was stored below 25°C. Oxygen cylinders and concentrators were available in the unit, which were being used by some of the residents’, however clear warning signs were not always displayed. The current months medicine charts were seen, which were hand-written by the nursing staff team, however there was no system in place to ensure the Worcester Intermediate Care Unit DS0000067999.V354406.R01.S.doc Version 5.2 Page 14 accuracy of these hand-written medicine charts. They were recorded with a staff signature to document administration of medication or an appropriate code used with a reason for not administering medication. Some medicine charts did not record the amount of medication administered. For example, one resident was prescribed a painkiller, ‘One or two to be administered four times a day when required’, however nursing staff had not recorded how many tablets had been administered. The medicine charts did not state the allergy status of the residents’. The receipt of medicine was recorded onto the medicine charts and a running stock balance was recorded in order to keep track of residents’ medicine requirements. The majority of the medication balances checked were accurate, which was noted as good practice however there were some balances that did not match the actual amount counted. There were repeated failures within the system, which meant that on several occasions some residents’ did not have their medication available. On one occasion the records show that one resident’s medication was borrowed in order to give to another resident who had run out of their medication. This is poor practice. A disposal record was available at the inspection, which showed that unwanted medication was placed safely in a special disposal bin for medication for destruction. Residents’ privacy and dignity was seen being respected when carrying out personal care and staff addressed residents in a respectful manner. Residents were able to choose whether they preferred a male or female carer as the unit employ male and female staff. A resident said staff ‘closed the bathroom door when washing’, and ‘knock on the door’ before coming into the room. Worcester Intermediate Care Unit DS0000067999.V354406.R01.S.doc Version 5.2 Page 15 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 good. This judgement has been made using available evidence including a visit to this service. People who use the service are able to make choices about their life style, although residents would benefit from the improvements highlighted by the service regarding supporting residents to continue their interests and more flexibility of mealtimes. EVIDENCE: A resident spoken with stated you ‘can do anything you want – fantastic place’. Staff said that they offer residents the opportunity to go into the garden; they watch television, listen to music and use the library. Written information from a relative stated ‘visiting my wife in the intermediate care unit is easy and no problem’. The staff and a resident told us that the visiting times had just been changed on a trial basis to enable the support of person centred care which is user focused and promotes independence and autonomy. Worcester Intermediate Care Unit DS0000067999.V354406.R01.S.doc Version 5.2 Page 16 The Annual Quality Assurance Assessment completed by the home prior to the inspection shows they have identified the need to make more time to allow residents to continue their usual activities whilst on the unit. This was discussed with the manager who said this was identified as part of the quality monitoring of the service. They aim to recruit an activities therapist to improve this aspect of the service. The residents spoken with when asked about the food stated, ‘absolutely brilliant’, ‘very good choice’, ‘choice of everything – choose day before, more than enough’, and ‘beautiful’. Residents can choose from a four-week rotating menu. Specialist diets are catered for. Another company provides the meals under contract as the unit is part of the same building as another home. The manager recognises that there could be more flexibility of mealtimes, but this is restricted due to the current contract in place for the provision of meals for this unit. Worcester Intermediate Care Unit DS0000067999.V354406.R01.S.doc Version 5.2 Page 17 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. People who use the service are able to express their concerns and have access to a robust, effective complaints procedure, and are protected from abuse. EVIDENCE: We have not received any complaints about this service since the last inspection. The home’s records show they have not received any complaints. The Annual Quality Assurance Assessment completed by the service prior to the inspection states ‘we work well with service users and their families to iron out any potential problems before they occur’. All staff spoken with were very clear about the home’s complaints procedures. Residents told us they were ‘aware of the complaints procedure’ and would ‘talk to Sue Perry the manager’. Written information from a relative stated ‘I have received no official information about this, but if I have wished to comment on any aspect of care I have done so to the manager and any comment has been well received and dealt with appropriately’. Written information from two general practitioners confirmed they had not received any complaints about the service. Worcester Intermediate Care Unit DS0000067999.V354406.R01.S.doc Version 5.2 Page 18 Two out of the three staff spoken with had received training on safeguarding people, and they were all very clear about the action they would take to protect the residents. The manager confirmed there are six staff who require safeguarding training and this is booked to take place in July 2007. The Annual Quality Assurance Assessment completed by the service prior to the inspection confirms all staff employed in the last 12 months have undertaken a satisfactory Criminal Records Bureau check. The staff file seen showed that a Criminal Records Bureau check had been done. Worcester Intermediate Care Unit DS0000067999.V354406.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The physical design & layout of the unit enables residents to stay in a safe, well-maintained and comfortable environment. It would be beneficial for residents if a further communal shower facility were provided as it would provide more flexibility and choice. EVIDENCE: The unit is contained within a purpose built care home. All rooms are single occupancy with en-suite toilets. The home is bright, clean, tidy and well maintained. A written comment from a relative stated, ‘the building was more like a hotel than a hospital, both regarding all the fixtures and fittings and it did not smell like a hospital’. Staff spoken with had all received training for the management of infection control and they had a good knowledge of the home’s infection control policies and procedures. Worcester Intermediate Care Unit DS0000067999.V354406.R01.S.doc Version 5.2 Page 20 The home currently has one communal shower facility as one of the bathrooms is used as an equipment store. A carer spoken with identified that it’s a problem with only one shower room. The manager discussed her ideas about how this could be resolved. The Annual Quality Assurance Assessment completed by the service prior to the inspection confirms that the building complies with the requirements of the local fire service and environmental health department and records are kept. Worcester Intermediate Care Unit DS0000067999.V354406.R01.S.doc Version 5.2 Page 21 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. Staff in the home are trained, skilled and available in sufficient numbers to support the people who use the service, and to support the smooth running of the service. Robust staff recruitment procedures promote the health and welfare of people using the service. EVIDENCE: At the time of the inspection there was a registered nurse and four care staff on duty. The manager was also on duty, but her hours were supernumerary to the staff rota. The home has vacancies at present for trained staff and due to this the manager is working as part of the rota three days each week. Staff spoken with confirmed that staffing levels were good. Residents spoken with when asked about the staff stated, ‘great, fabulous, will do anything for us’, and you ‘do not have to wait for anything’. ‘Staff are never unhappy, they never moan’, you ‘never hear a harsh word’. Written comments from relatives stated, ‘the staff were very good and caring’, and ‘all the staff were very caring in their attitude’. The Annual Quality Assurance Assessment completed by the service prior to the inspection confirms eight staff have NVQ level 2 or above and 38 of staff are working towards NVQ level 2 or above. Staff spoken with one had achieved NVQ level 2 and one had NVQ level 2 and 3. Worcester Intermediate Care Unit DS0000067999.V354406.R01.S.doc Version 5.2 Page 22 A staff file seen confirms that all the information and checks required prior to appointment of staff are undertaken by the home. Three staff spoken with had received the core training such as fire, moving & handling and health and safety. Staff have also received training in basic life support, dementia care, pressure area care, food hygiene, infection control and one carer had received training to carry out extended duties such as removing clips from wounds, taking residents blood pressure, temperature and blood sugar monitoring. Staff files and discussion with staff confirmed that they receive a six-month induction when appointed. The Annual Quality Assurance Assessment states they aim to review the staffing ratios for the home as they admit more dependent residents. Worcester Intermediate Care Unit DS0000067999.V354406.R01.S.doc Version 5.2 Page 23 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, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management and administration of the home is based on openness and respect, and has effective quality assurance systems developed by a qualified, competent manager. The health and safety of residents and staff are promoted and protected. EVIDENCE: The unit is managed by a well-trained and competent manager. She has managed this unit since it opened in 2001, which has provided stability for the service. Staff told us they have staff meetings and talk about how they can improve the care and routines and when asked about how the unit is managed stated it is ‘very open management’. Worcester Intermediate Care Unit DS0000067999.V354406.R01.S.doc Version 5.2 Page 24 The home has quality monitoring systems in place and they also consult the residents about the service. The manager has identified some areas that need improvement through this process, for example the need to employ a diversional therapist, the shortfalls in completion of the care records within 72 hours of admission and the need for supernumery time for these key staff to enable them to achieve this, improvements to the cleaning service at weekends. It is evident from reading the minutes of a recent staff meeting, staff are consulted about changes and they are discussed at the meetings. An Annual Quality Assurance Assessment was completed by the manager prior to the inspection. This is a new document that we require services to complete. It contained clear and relevant information, supported by evidence. It told us about the changes they have made and where they still need to make improvements. Monies were being kept securely by the service for one of the resident’s case tracked. The records were clear and identified staff and the resident signed for deposits and withdrawal of monies. Statutory training is carried out for staff in health and safety, food hygiene, fire moving & handling and infection control. A certificate was seen for the cleaning and chlorination of the water system in May 2007 and recorded monthly checks for the hot and cold water temperatures and window restrictors. The Annual Quality Assurance Assessment shows that all equipment has been serviced and tested in 2007. Worcester Intermediate Care Unit DS0000067999.V354406.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Worcester Intermediate Care Unit DS0000067999.V354406.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1)(2) Requirement Care plans must be in place and sufficiently detailed to enable staff to understand and meet the health and care needs of residents. Suitable arrangements must be implemented to ensure that residents’ medication is available to administer as prescribed by a medical practitioner in order to ensure the health and welfare of service users taking medication are safeguarded. Medication records must document the amount of medication administered to a service user in order to ensure the health and welfare of service users taking medication are safeguarded. Timescale for action 30/06/08 2. OP9 13(2) 31/05/08 3. OP9 13(2) 31/05/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Worcester Intermediate Care Unit DS0000067999.V354406.R01.S.doc Version 5.2 Page 27 No. 1. Refer to Standard OP9 Good Practice Recommendations A system should be introduced which demonstrates that medication is stored at a safe temperature in order to ensure that people who use the service are protected from harm. It is recommended that any hand- written medicine charts are double- checked and signed by a second member of staff to agree that the medication details recorded were correct. It is recommended that all residents’ allergy status is documented on their medicine record charts in order to ensure the safety of residents. It is recommended that ‘oxygen storage’ warning signs are clearly displayed wherever oxygen is located in order to ensure the safety of residents and staff. It is recommended that the service see all prescriptions in order to check the medication order and to have sight of the only document signed by a general practitioner. This is in order to ensure that the handwritten medicine charts for the residents are correct. 2. OP9 3. 4. 5. OP9 OP9 OP9 Worcester Intermediate Care Unit DS0000067999.V354406.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW 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. 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