CARE HOMES FOR OLDER PEOPLE
Zapuzino 205 Alexander Drive Cirencester Glos GL7 1UH Lead Inspector
Sharon Hayward-Wright Unannounced Inspection 20th January 2006 10:40 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 Zapuzino DS0000016662.V277616.R01.S.doc Version 5.1 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. Zapuzino DS0000016662.V277616.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Zapuzino Address 205 Alexander Drive Cirencester Glos GL7 1UH 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) 01285 651057 Mrs Rosemary Teresa Kilby Mrs Rosemary Teresa Kilby Care Home 6 Category(ies) of Old age, not falling within any other category registration, with number (6) of places Zapuzino DS0000016662.V277616.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 13th July 2005 Brief Description of the Service: Zapuzino is a small care Home within a large housing estate on the outskirts of Cirencester town. The Home is within a quiet cul de sac and surprisingly unobtrusive. Once inside, the Home offers single accommodation for older people who requires assistance and supervision in some of their daily activities. The communal lounge/diner on the ground floor has been enlarged following an extension of a small conservatory area. This now provides the Home with separate dining facilities. Other accommodation consists of one bedroom that is located on the ground floor; this has communal bathing and toilet facilities next door. Five other bedrooms are located on the first floor, accessed by a stair lift and one of these has en-suite facilities, with the other four providing hand wash basins. The home does not have waking night staff and emergency night cover is provided by the Registered Provider/Manager. Zapuzino DS0000016662.V277616.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 2 hours on one day in January 2006. Five service users were spoken with to gain their views on the home and the care provided. One staff member and the Registered Provider/Manager were also spoken with. Staff were observed going about their duties and interacting with each other and service users. A part tour of the premises took place and care and training records, duty rotas, complaints, maintenance records and personnel files of new staff were inspected; and requirements from the previous inspection were followed up. The Registered Manager/Provider has made very good progress at addressing the requirements issued at the last inspection. What the service does well: What has improved since the last inspection?
Zapuzino DS0000016662.V277616.R01.S.doc Version 5.1 Page 6 The home has now completed their Statement of Purpose/Service Users Guide with the required information as directed by the Care Homes Regulations. This joint guide now provides service users and prospective service users with information about the services provided by the home. The home has moved the medication cupboard from the kitchen to another room so the temperature of the medications stored can be constant. The home has also reviewed their administration procedure to ensure the medication is held securely at all times. The home has had a recent Environmental Health visit and they were happy with the home; a few minor recommendations were made and the Registered Manager/Provider said she would address these. Since the last inspection the standard of vetting and recruitment practices has improved, however not all the appropriate checks have been carried out and this could potentially leave service users at risk. Records of the hours that staff work are now being kept. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Zapuzino DS0000016662.V277616.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Zapuzino DS0000016662.V277616.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 The homes’ Statement of Purpose/Service Users Guide provides service users and prospective service users with details of the services the home provides enabling an informed decision about admission to the home. EVIDENCE: The home has now completed their Statement of Purpose and Service Users Guide as required by the Care Homes Regulations. The home has combined both of these guides to provide service users with the information they need about the services provided by the home. Zapuzino DS0000016662.V277616.R01.S.doc Version 5.1 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 9 The system for administration of medication has improved since the last inspection; with arrangements in place to ensure service users medication needs are met. EVIDENCE: No standards were assessed in full at this inspection only requirements and recommendations made at the last inspection. The Registered Manager/Provider is looking to review the format used for care plans. The requirements and recommendation issued in relation to medication at the last inspection have been addressed. Zapuzino DS0000016662.V277616.R01.S.doc Version 5.1 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: No standards were assessed at this inspection. The Vicar was visiting the home during the inspection undertaking a service with the service users. Zapuzino DS0000016662.V277616.R01.S.doc Version 5.1 Page 11 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 There is a complaints system in place with but to date this has not been tested. Arrangements are in place for protecting service users from the possible risk of harm and abuse. EVIDENCE: The home has not received any complaints since the last inspection. A copy of the home’s complaints procedure is included in their Statement of Purpose/Service Users Guide and a copy is displayed downstairs. The Registered Manager/Provider feels that as a small home any issues are identified and addressed quickly. The home has policies in place to protect vulnerable adults and has a copy of the Department of Health ‘Protection of Vulnerable Adults Scheme’. The Registered Manager/Provider said all staff have read these policies. From discussions with a staff member they have undertaken training in their NVQ 3 in relation to this subject. It is recommended that the home obtain a copy of the Gloucestershire Alters Guide from the Adults at Risk team. It is also recommended that training in this area be provided for staff. Zapuzino DS0000016662.V277616.R01.S.doc Version 5.1 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 The standard of the environment within this home is satisfactory and provides the service users with an attractive and homely place to live. However several issues still need to be addressed to improve the environment for service users and to ensure they are not put at risk. EVIDENCE: A part tour of the premises took place to review the maintenance issues identified at the last inspection. Two areas have been completed but the ones listed below are outstanding and must be addressed; these are: 1. In the room identified by the service users name initial E; the unit housing the sink has damaged doors and again is an infection control risk. 2. In the room identified by the service users name initial K; the doors are missing to the sink cupboard and the draws have been damaged.
Zapuzino DS0000016662.V277616.R01.S.doc Version 5.1 Page 13 3. In the room identified by the service users name initial B; the area of the wall that has been plaster boarded must be decorated. 4. In the communal bathroom on the first floor there are tiles missing from the wall that must be replaced. Zapuzino DS0000016662.V277616.R01.S.doc Version 5.1 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28, 29 & 30 Since the last inspection the standard of vetting and recruitment practices has improved, however not all the appropriate checks have been carried out and this could potentially leave service users at risk. Training opportunities have been provided for staff to improve their skills but there are inconsistencies with not all staff receiving training appropriate to the tasks they are to perform. EVIDENCE: The home has five staff members, four of which are care staff. Two of these have NVQ 3. Since the last inspection one new staff member has started at the home. All the required information was present except evidence of their address. This is vast improvement since the last inspection. The home also has a work experience person at the home from a local college. The home must confirm with the college that suitable checks have been undertaken to include a Criminal Records Bureau check. A copy of the homes’ induction programme was seen and the Registered Manager/Provider also uses the TOPSS booklet to ensure they are working with their specifications. Evidence was seen of training for staff to include food and hygiene and infection control. The nominated first-aider requires an update.
Zapuzino DS0000016662.V277616.R01.S.doc Version 5.1 Page 15 The home must also ensure all staff receive some form of first aid training. In relation to moving and handling training it was suggested that a member of staff is trained to be a trainer then they can disseminate the information to the other staff. The Registered Manager/Provider has just completed a course on dementia and the two senior care staff are planning to undertake this training. Zapuzino DS0000016662.V277616.R01.S.doc Version 5.1 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 34 & 38 The Registered Manager/Provider has a supportive, open approach to running the home, which benefits the service users, staff and relatives. So far as is reasonably practicable the health, safety and welfare of service users, staff and visitors are protected, however the home is not undertaking all the required safety training. EVIDENCE: There have not been any changes to the Management of the home. The Registered Manager/Provider said she has completed the NVQ 4 training and recently undertaken an ASET course about Dementia. She is aware of the importance of keeping herself updated with training. A recommendation made at the last inspection for the home to document their business and financial plan has not addressed. This recommendation has been made again.
Zapuzino DS0000016662.V277616.R01.S.doc Version 5.1 Page 17 Evidence was seen of servicing of equipment. There were no records to provide evidence that staff have received fire training. The home must ensure that staff receive fire training to reduce any risks to service users. Records of fire alarm testing etc was not inspected as the home has had a fire officer visit recently. Environmental Health has also recently visited the home and a copy of their report was seen. The Registered Manager/Provider said she is going to address the recommendations made at this visit. Zapuzino DS0000016662.V277616.R01.S.doc Version 5.1 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 x x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 x 8 x 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 2 x x x x x x x STAFFING Standard No Score 27 x 28 4 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x x 2 x x x 2 Zapuzino DS0000016662.V277616.R01.S.doc Version 5.1 Page 19 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP19 Regulation 23(2b) Timescale for action The Registered Manager/Provider 30/04/06 must address the maintenance issues identified in standards 1926. Timescale of the 18/10/05 was not met. The Registered Manager/Provider 28/02/06 must obtain evidence that appropriate checks have been undertaken on the work experience person to include a Criminal Records Bureau check. The Registered Manager/Provider 28/02/06 must obtain evidence of the new member of staff address. The Registered Manager/Provider 01/07/06 must ensure that training is provided for staff for the tasks they are to perform. The Registered Manager/Provider 01/03/06 must ensure staff receive fire training as directed by the Fire Service and records must be maintained as evidence. Requirement 2 OP29 7, 9, 19 & Sch 2 3 4 OP29 OP30 7, 9, 19 & Sch 2 18 1 (ci) 5 OP38 23 4(d.) Zapuzino DS0000016662.V277616.R01.S.doc Version 5.1 Page 20 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 2 Refer to Standard OP18 OP18 OP34 Good Practice Recommendations The home should provide training for staff in protection of vulnerable adults. The home should obtain a copy of the Gloucestershire Alters guide from the Adults at Risk Team. The home should have a written business and financial plan that is reviewed yearly. Zapuzino DS0000016662.V277616.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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