Care Home: Dewi-Sant

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What the care home does well Some of the staff team recognise that how people are treated and how care is provided has to change from previous practice for everyone`s benefit. One care assistant told us "It`s so much better now, although we have to learn new ways of doing things. We must make sure that our ladies and gents come first and look after them better". What the care home could do better: We are concerned about the risk to the people residing at Dewi Sant and any injuries that may be sustained because protective measures are not in place. We made an Immediate Requirement following this visit regarding concerns in respect of health and safety of the premises. We followed this with a meeting with the provider to ensure immediate and prompt actions would be taken to make the premises of Dewi Sant safe and "fit for purpose". One requirement made at the key inspection in March 2009 and repeated at the last inspection in July 2010 was still not met by the time of this visit. One employee was continuing to stall in complying with requests by the relief manager to provide information required for a Criminal Records Bureau (CRB) check to be completed. No disciplinary action was being taken by the provider about this. An Immediate Requirement was therefore made at this visit for the individual to provide any information required by the relief manager to ensure they are fit and suitable to be employed to work in a care home. We are concerned that roles and responsibilities, and lines of accountability are not clear because of the behaviour and attitudes of some key staff employed to work at Dewi Sant. We made an Immediate Requirement about this at the time of this visit. This has been partially met however we do not have confidence that the provider has briefed staff in key positions about their roles and responsibilities, and the boundaries of those positions. This lack of clarity and laissez faire approach by the provider continues to put the people residing at Dewi Sant at risk. We have concerns about the arrangements for giving people their medicines, and the way that medicines are stored and recorded. Untrained staff are giving people medicines that have been dispensed by another staff member. This is not a safe way to give medicines and is not good practice. There should be clear records to show that all medicines are given or applied as people`s doctors have prescribed for them. It is recommended that all handwritten entries are checked and signed by a second member of trained staff. This will reduce the risks of errors occurring. The requirement made at the previous inspection about medicines information in care plans has not been met and is repeated at this inspection. This will help to make sure that people receive their medicines in the way the prescribing doctor has intended for them.We are concerned about the staffing situation with regard to medicine training, especially the over-night arrangements. This needs to be reviewed to ensure that people can always receive their medicines safely and whenever necessary, by trained and competent staff. We are concerned about the security of medicines kept in unlockable cupboards in the clinic room and refrigerator, and storage of the medicine cupboard keys overnight. These must all be reviewed to ensure that medicines are stored safely and securely for the protection of people in the home. We are concerned that the staff at Dewi Sant are not grasping the fundamentals and importance about how to meet people`s health and social care needs. We are concerned that the staff require continuous direction and supervision to ensure they carry out their work. We are concerned there are no systems in place to enable the staff to work together as a team promoting the wellbeing of the people residing at Dewi Sant. We are concerned that information about individual people is not kept confidential. We are concerned that record keeping continues to be poor or non existent. We are concerned that the relief manager and the deputy manager repeatedly write the same reminders to staff in the Staff Communications Book. These are all reminders about people`s dignity, choice and well being. We are concerned that staff do turn off the heaters because they themselves are hot. The home is heated with night storage heaters and these do not provide instant heat when switched back on. We are concerned that because heaters are switched off or do not work it is not possible to heat the home quickly and adequately throughout. The staff at Dewi Sant are undergoing a lot of training to enable them to improve their care practice. We are concerned that we still found they have an institutional approach to providing care and continue to revert to accustomed practice if they are not strictly supervised at all times. This means that the relief manager is unable to achieve putting in place safe systems and better care practice. We are concerned that there has been no significant improvement in the two months since our last visit and requirements made at the last inspection have not been met. Random inspection report Care homes for older people Name: Address: Dewi-Sant 32 Eggbuckland Road Mannamead Plymouth Devon PL3 5HG two star good service 20/03/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Megan Walker Date: 2 8 0 9 2 0 1 0 Information about the care home Name of care home: Address: Dewi-Sant 32 Eggbuckland Road Mannamead Plymouth Devon PL3 5HG 01752664923 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mannarest Limited Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 34 Number of places (if applicable): Under 65 Over 65 0 34 dementia old age, not falling within any other category Conditions of registration: 34 0 The maximum number of service users who can be accommodated is 34 The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) Dementia (Code DE) Date of last inspection 2 3 0 7 2 0 1 0 Care Homes for Older People Page 2 of 20 Brief description of the care home Dewi Sant is a care home providing accommodation and personal care for up to thirtyfour older people, some of whom may have a dementia. It is privately owned by Mannarest Limited. The home is a large, three-storey, detached building, converted into a care home approximately forty years ago and located in the residential area of Mannamead. The home is within walking distance of shops in Mutley Plain and close to bus services into central Plymouth and the railway station. All the bedrooms are single and none of them have en-suite facilities. There are eighteen bedrooms on the ground floor, eleven on the 1st floor and four on the 2nd floor. The top two floors can be reached using the stairs or the stair lifts on each flight. Communal rooms are on the ground floor and consist of two lounge rooms, a dining room and a conservatory with doors out onto a patio. Because of the layout of the home it is not suitable for people who use wheelchairs. The home has limited parking space at the back of the house but unlimited on street parking is available at the front. Information about the home, including copies of inspection reports, can be obtained from the home. Care Homes for Older People Page 3 of 20 What we found: This was a random inspection undertaken by one compliance inspector and one pharmacist inspector to check compliance with regulation. At the last random inspection on Friday 23rd July 2010 we found significant and serious concerns about the safety and wellbeing of the people using this service. We also found requirements made at the key inspection in March 2009 were still not met. The fieldwork part of this inspection was unannounced and took place on Thursday 23rd September 2010 between 07:40 and 18:25. An Expert by Experience joined part of our visit between 10:30 and 14:30. The Care Quality Commission (CQC) considers an Expert by Experience as a person who either has a shared experience of using services or understands how people in this service communicate. On arrival we were met by a care assistant who was on duty and working the night shift. There was also an agency care assistant on duty. Care staff due to work the day shift were arriving and awaiting a handover from the night care staff. Two other care assistants were waiting at the home to be taken to a mental health awareness training course. We made a tour of the premises. We found eight people were up and sitting in the lounge. One person was wearing a summer-weight knee length nightdress and summerweight knee length dressing gown. Everyone else was dressed. Six people were asleep in their chairs. The television was turned on. The lounge next door was empty. The television was turned on. We found six people sitting in their chairs in their bedrooms. One person was awake and able to communicate to us that he wished to be up and out of bed. One person was able to talk to us however they could not tell us how long they had been sitting in the chair. We looked at the night care records. We found these had started on 13th September 2010 and there were hourly checks recorded. The times of the checks were unclear because staff were inconsistent with their use of 24 hour time keeping. They did not indicate am or pm either. There was evidence of some people woken up with a cuppa at 07:30. One person was up and in lounge by 07:30 every day. For one person the night staff had recorded 06:30 awake but refused to get up. We asked the night care staff about the people who were already up. We were told that if people come out of their rooms twice then they are brought downstairs to the lounge. We were told this was safer so we can see what they are doing. We asked if anyone has an alarm of any sort fitted in their bedroom or outside their bedroom door. [An alarm would be fitted if a multi disciplinary assessment showed the person was at risk if they were to leave their bed or their room unsupervised. An alarm serves as an alert for the staff.] We were told that with only two staff members on duty, they do not have sufficient time to stop what they are doing (i.e. getting people up), to go and check on people. The night staff confirmed no one on the day of our visit had got up before 06h00. We looked at the Staff Communications Book. On 08/09/2010 we found a message from the relief manager to all the night staff that all residents were to have a cup of tea in their bedroom at 07:30. On 13/09/2010 we found a further note to all care staff that they Care Homes for Older People Page 4 of 20 should encourage choice with common sense and if people wished to stay in bed then they should be left but to make sure they were getting up by 10:00. We found this was because the night staff were getting people up from 05h30 so that at least twelve people were up and dressed before the day staff arrived to start their shift. We found that the people sitting in the lounge since before 07h30 were offered breakfast between 09h00 and 09h30. We found no evidence of anyone in the lounge being offered a drink or anything to eat whilst waiting for breakfast. We were concerned because these are people who have a limited notion of time and may be unaware they are sitting for up to three hours without a drink or food. One person we asked was unable to tell us if they had eaten anything since teatime (17h00) the evening before. We observed breakfast for those people who were able to get themselves up and make their way to the dining room as well as those people who needed prompting and assistance. We found that for the people who needed assistance they were not offered a choice of food or hot drink. Cereal was put out in bowls with milk, in some cases before the person had sat at the table. We found on the serving hatch individual plates laid out with one slice of buttered toast. We were later told that an occasional opportunity to have a cooked breakfast is being introduced however no-one has yet taken up this option. One person told us that they enjoyed porridge for breakfast and this was available if requested. We found that previously there were two sittings for lunch however on the day of our visit the lunchtime meal was served in one sitting in the dining room. Most people had arrived in the dining room by 12h15. No meals were taken in the lounges, conservatory or bedrooms. The plated lunch was stewed steak with gravy, mixed vegetables and roast potatoes accompanied by fruit squash or water, and followed by jelly and fruit. The meal was well presented and hot. People did not enthuse about the food, several describing it as being adequate, OK and alright. There were no complaints about the quantity. There was no choice for lunch. Anyone preferring an alternative was offered cold meat with the same vegetables as served with the hot meal. Tea time we were told would be hotdogs in a roll with onions. There was no indication of a choice or alternative for anyone who did not want hotdogs. Pureed meals were served in the identifiable constituent parts although we do not know how other meals (breakfast, tea and snacks) are served as we did not see these. On Sundays a roast dinner is served. One person told us that it is possible to have a hot meal in the evening. The cook confirmed that a meal would be cut out and kept for the evening if requested. We observed a care assistant taking orders for the following days meals late afternoon on the day of our visit. We suggested to the relief manager that this could be confusing especially as it was just before teatime. The relief manager told us that care staff have been told to ask people about meals mid-morning on the same day they will eat the meal. We found a message written in the Staff Communications Book requesting that snacks be made available to people with the evening hot drinks trolley as the last meal is at 17h00. The staff member reported that some people were asking for sandwiches by 19h00 because they were hungry. The cook told us that food in the kitchen is accessible to staff in the evening and night should the need arise. We looked at arrangements for medicines in the home. We found that there are only four Care Homes for Older People Page 5 of 20 care staff who are trained to give medicines in the home, and rotas have to be arranged to make sure one of these people is working each daytime shift. At night we were told no one has any regular medicines prescribed for them at the moment. The night care staff would have to contact an on-call staff member to come and administer any when required medicines such as pain killers. The on-call number is available to staff in the clinic room, but is clearly marked to be used for emergencies only. We were told that the keys to the medicines cabinets are left in an unlocked cupboard at night so they are available to night staff, although they are not trained to give medicines. Some more members of staff have recently received training from the pharmacist but are not yet assessed as competent, and so are not giving medicines to people at the moment. We watched some medicines being given to people at lunchtime and saw that they were given to people one at a time in a safe way. However when we arrived at the home in the morning we heard untrained staff asking if they should take medicines dispensed by a trained member of staff to give to someone. We were told that this happens sometimes in the home. We found that medicines are stored in a clinic room, the door of which is usually left open. Most medicines, including controlled drugs, are stored safely and appropriately in locked cupboards, but we found some strips of tablets and some external preparations that are kept in unlockable cupboards in this room. There is a trolley which is locked but not chained to a wall. We were told that a separate refrigerator for medicines has been ordered but has not arrived yet. At the time of our visit some medicines were being kept in the kitchen refrigerator, but they were not locked or kept separate from foods. We checked the medicine records for all people living in the home. We found some gaps in the records where it is difficult to tell whether doses have been given to people for various medicines, including external preparations such as creams and ointments. We found one medicine prescribed to be given once a week, that had not been given for 3 weeks. We found some handwritten entries on medicine charts that had not been signed by staff. We looked at care plans for seven people residing at Dewi Sant and found very little information about peoples medicines. There is usually a list of medicines that people were taking when they first came into the home, but no up to date list of peoples current medicines. For one person who was prescribed a course of antibiotics we could find no record of a GP visit or details of why these antibiotics were prescribed. One person had information in their plan that cream should be applied twice a day, but it was recorded that these were applied some days but not others. We also found a note in the staff communications book that the creams needed to be applied, as it does not appear to be being done. We were told that one person was applying one of their own preparations but there was no record of this in the care plan, no details of how they should be applied on the label, or any risk assessment to show that it has been considered safe for this person. We found a lot of confidential information about individuals recorded in the Staff Communications Book. A lot of this information was very detailed as well as personal. We advised the relief manager that staff should record information in the individuals care files to protect confidentiality. Care Homes for Older People Page 6 of 20 We found that care plans are still sparse with information. We found more information about peoples health, changes to medicines, and ongoing care needs in the Staff Communications Book. The relief manager advised us that writing new informative care plans was a piece of work requiring training and one to one work with the care staff to ensure they are able to reflect in detail how peoples care needs are to be met. We found throughout our visit that both televisions remained on in both lounges for the duration of the day. This included different periods of time when care staff were playing Bingo and earlier, dancing, with the people residing at Dewi Sant. We spoke to people about their daily life at Dewi Sant and what they did. One person told us that they didnt do a lot. Several people said they thoroughly enjoyed the weekly visits of a therapist with her armchair activities involving skittles, soft balls and hoop-la. People did not have a high opinion of some of the few other activities by visiting entertainers. The relief manager indicated that she was actively seeking more interesting alternatives. Some people told us that they went out with their families. We overheard a care assistant explaining to a couple of people about the role of a key worker. He told them that they would be able to go out for dinner and to go shopping into town if they so wished with their key worker. The relief manager confirmed that the care assistants could take people out for planned meals and trips into the city centre on an occasional basis. They use taxis as the home does not have a vehicle at its disposal. The relief manager told us that she was keen to promote enabling people to be actively involved in the local community, including going out on a one-to-one basis with their key worker. We found that many people who live at Dewi Sant have not left the premises since the day they moved in, and in some cases this was a long time. We found on our last visit that most of the people using this service were sitting either in the lounge or in the conservatory. Peoples walking frames and other walking aids were lined up in the hall or the conservatory. We found this was the same practice on this visit. This means that anyone who uses equipment to assist with standing and or walking is unable to do so without staff assistance. We found that one of the remote controls for the chair lift did not work. A care assistant told us it had not worked for months. This means that people cannot independently use the chair lift. Whilst observing someone use the chair lift we noticed that the safety strap was buckled up and tucked into the back of the chair so it was sat upon. We found that it was not used either by those people able to independently use the chair or by care staff assisting people to use the chair lift. This means that people are not safe and at risk of falling out of the chair whilst it is in motion. At different times during our visit we sat in each of the lounges to observe interactions between the people residing at Dewi Sant and the care staff. We found the staff were task orientated. There was no obvious reluctance on the part of staff to provide assistance on demand. When using a recently acquired standing aid the care assistants kept the person being assisted fully informed and ensured that the manoeuvre was completed safely. The staff addressed people respectfully although we heard a care assistant calling out Feet ladies, feet as a wheelchair was manoeuvred into a lounge. The people sitting in the lounge did not respond as they were asleep. The same care assistant however was observed at other times as attentive to people and giving assistance where required. No-one said they had any difficulties understanding language Care Homes for Older People Page 7 of 20 or accent although in group situations, for those people who have a hearing impairment, the staff are not always clear when they speak. The people we asked about response to the call bells told us generally they received the care and attention they expected although there could be delays of 5 to 10 minutes. All spoken with were aware that a new call bell system had been installed recently. We found that the care staff congregate in the hallway chatting amongst themselves. This was an observation reported on at our last visit. We found that care staff take extended cigarette breaks together. The smoking area is outside in a sheltered area in the garden. We found overall much of the communication and interaction we observed was either task based or based around information giving. We found the routines of the day continue to be time and task orientated. We found the staff lack initiative and require prompting and direction from the relief manager. Whilst in the dining room we found that new flooring (fitted since our last inspection) was very slippery. Later during our visit we had to walk across the dining room to speak to the cook in the kitchen. The floor had been washed and was still damp. Again we found it was slippery. It also had a raised edge where two pieces had been adjoined and it was poorly fitted. We found many of the bedrooms were cold. In one bedroom we found the occupant had got back into bed fully dressed because they were cold. This room like several others smelt damp and we found evidence of mould on the walls. There was also evidence of damp and mould in the lounges. One staff member showed us where at least once a week furniture, walls and windows in certain rooms all needs to be wiped down to prevent a build up of mould caused by damp, poor ventilation and poor heating. We found evidence of mould in three different bedroom cupboards. One of these cupboards is used for the persons clothes. A temperature chart of downstairs bedrooms showed the average bedroom temperature over a period of a week was 20 degrees celsius. We found a number of environmental issues including mould and fungal growths, condensation, rising and penetrating dampness, heaters without safety guards, scalding hot water without warning signs, the dining room flooring causing a slip and/or trip hazard, and as it is not impermeable and is poorly fitted at the edges it is not easily cleanable; and similarly the poor condition of the laundry facility. We found that when a care assistant was asked by the relief manager to check all the heaters were switched on, the care assistant reported that some were turned off and others were not working. On the day of our visit it was a warm sunny morning and pleasant for those people in south facing rooms and able to sit in a sunny position. Several of the staff complained they were too hot. The relief manager told us that all the staff had been told not to turn off heaters. We found that duvets were thin and summer weight. The covers were tired and worn. The sheets were also thin. The relief manager told us new double duvets, duvets covers, pillows and pillow cases have been ordered to replace all the current bedding used by the people residing at Dewi Sant. We asked her to ensure that beds have mattress protectors in order to give an extra layer and comfort underneath people whilst they are in bed. An audit of all the beds has been completed. Some beds were disposed of and others moved around from vacant rooms to rooms where they are more suitable for peoples needs. At the time of this visit the relief manager confirmed that no one needed assistance with a Care Homes for Older People Page 8 of 20 hoist to get in or out of bed, and the divan beds continued to be functional in the short term. We found that between 08h00 until 14h00 on duty there are five care assistants, a housekeeper and a chef; from 14h00 until 21h00 there are four care assistants, and a kitchen porter works 16h00 to 18h00 or 16h00 until 20h00. No-one could tell us why the kitchen porters hours are variable. Overnight there are two care staff with an additional third care assistant sleeping if risk assessments showed this would be beneficial. We found that the two housekeepers are employed to clean the whole of the premises and manage the laundry. The night staff are responsible for the ironing. On the day of our visit only one housekeeper was working as the second was on a day off. The housekeeper explained that there are two days each week when there is one housekeeper and five days when they overlap. This ensures housekeeping duties are covered every day of the week. At times of holiday or sickness the remaining housekeeper covers all days. We asked about moving and handling training as twice we found the housekeeper single-handedly transferring delivery loads through the house and, on the second occasion into the cellar. She told us that the housekeepers have not had any moving and handling training. We found that the relief manager works variable hours and is not included on the staff rota at present. She is reviewing and setting up new roles for the care staff. The senior care staff position has been removed as part of this review and change. Internal rotation across both day and night shifts and a key worker system are being introduced for all the care staff. There is also a review of the housekeepers tasks with plans to advertise for an additional housekeeper and introduce responsibility solely for the laundry to one housekeeper. This is not feasible at present because the laundry building is not fit for purpose. Since our last inspection visit the Devon and Somerset Fire and Rescue Service; the Environmental Health Team, and the Infection Control Team have undertaken safety audits, and their respective reports sent to the provider to action requirements and recommendations. There are ongoing reviews by social and health care teams as part of the safeguarding process. Some people have moved to other care homes in the city because their reviews showed their care needs would be met more appropriately elsewhere. The local authority is providing training to all staff on a number of subjects and has already included safeguarding vulnerable people, and Dignity in Care. During our visit a fire safety officer from the Devon and Somerset Fire and Rescue Service conducted a practical training session on fire safety. Agency care staff covered part of the shift to enable as many staff as possible to attend this training session. Two staff were attending a Mental Health Awareness training course for two days. On their return to Dewi Sant at the end of the first day they were enthusiastic and felt they were learning a lot that could be introduced for the benefit of the people residing at the home. The relief manager advised us that in October and November four care staff were due to attend a course about caring for people with dementia care needs, and four other staff would be attending a four part course about continence care. The relief manager confirmed that she is actively seeking out and setting up as much training as possible with external accredited trainers because all training previously has been in-house. Facilitating the staff Care Homes for Older People Page 9 of 20 of Dewi Sant to attend external training sessions means they will have learning and development opportunities to enable them to carry out their role and keep their skills up to date. What the care home does well: What they could do better: We are concerned about the risk to the people residing at Dewi Sant and any injuries that may be sustained because protective measures are not in place. We made an Immediate Requirement following this visit regarding concerns in respect of health and safety of the premises. We followed this with a meeting with the provider to ensure immediate and prompt actions would be taken to make the premises of Dewi Sant safe and fit for purpose. One requirement made at the key inspection in March 2009 and repeated at the last inspection in July 2010 was still not met by the time of this visit. One employee was continuing to stall in complying with requests by the relief manager to provide information required for a Criminal Records Bureau (CRB) check to be completed. No disciplinary action was being taken by the provider about this. An Immediate Requirement was therefore made at this visit for the individual to provide any information required by the relief manager to ensure they are fit and suitable to be employed to work in a care home. We are concerned that roles and responsibilities, and lines of accountability are not clear because of the behaviour and attitudes of some key staff employed to work at Dewi Sant. We made an Immediate Requirement about this at the time of this visit. This has been partially met however we do not have confidence that the provider has briefed staff in key positions about their roles and responsibilities, and the boundaries of those positions. This lack of clarity and laissez faire approach by the provider continues to put the people residing at Dewi Sant at risk. We have concerns about the arrangements for giving people their medicines, and the way that medicines are stored and recorded. Untrained staff are giving people medicines that have been dispensed by another staff member. This is not a safe way to give medicines and is not good practice. There should be clear records to show that all medicines are given or applied as peoples doctors have prescribed for them. It is recommended that all handwritten entries are checked and signed by a second member of trained staff. This will reduce the risks of errors occurring. The requirement made at the previous inspection about medicines information in care plans has not been met and is repeated at this inspection. This will help to make sure that people receive their medicines in the way the prescribing doctor has intended for them. Care Homes for Older People Page 10 of 20 We are concerned about the staffing situation with regard to medicine training, especially the over-night arrangements. This needs to be reviewed to ensure that people can always receive their medicines safely and whenever necessary, by trained and competent staff. We are concerned about the security of medicines kept in unlockable cupboards in the clinic room and refrigerator, and storage of the medicine cupboard keys overnight. These must all be reviewed to ensure that medicines are stored safely and securely for the protection of people in the home. We are concerned that the staff at Dewi Sant are not grasping the fundamentals and importance about how to meet peoples health and social care needs. We are concerned that the staff require continuous direction and supervision to ensure they carry out their work. We are concerned there are no systems in place to enable the staff to work together as a team promoting the wellbeing of the people residing at Dewi Sant. We are concerned that information about individual people is not kept confidential. We are concerned that record keeping continues to be poor or non existent. We are concerned that the relief manager and the deputy manager repeatedly write the same reminders to staff in the Staff Communications Book. These are all reminders about peoples dignity, choice and well being. We are concerned that staff do turn off the heaters because they themselves are hot. The home is heated with night storage heaters and these do not provide instant heat when switched back on. We are concerned that because heaters are switched off or do not work it is not possible to heat the home quickly and adequately throughout. The staff at Dewi Sant are undergoing a lot of training to enable them to improve their care practice. We are concerned that we still found they have an institutional approach to providing care and continue to revert to accustomed practice if they are not strictly supervised at all times. This means that the relief manager is unable to achieve putting in place safe systems and better care practice. We are concerned that there has been no significant improvement in the two months since our last visit and requirements made at the last inspection have not been met. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 11 of 20 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 3 14 You must ensure that no-one 31/08/2010 is admitted to the care home unless they have had a satisfactory assessment performed. This is to ensure staff are aware of the needs of the person and have made a decision they are able to meet those needs. This shows that staff are able to meet the needs of the person before they come to the home and to help staff prepare what equipment and training is needed. 2 7 15 You must ensure that care 28/09/2010 plans and risk assessments are accurate, are reviewed to show changes and contain accurate information to enable staff to provide care in a safe and consistent way. This will ensure staff will be aware at all times what care an individual needs. 3 8 12 You must ensure systems are 31/08/2010 in place to make certain people receive the finer details of care that allows them to make decisions about their lives. Page 12 of 20 Care Homes for Older People Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action This will ensure that care staff involve people in their care. 4 9 13 You must ensure that care 20/08/2010 plans include detailed information for staff about the administration of medicines to people, and risk assessments where people manage their own medicines. This is to make sure people receive their medicines correctly and safely, in the way their doctor has prescribed 5 9 13 You must ensure that 20/08/2010 arrangements are made to make certain that medication is stored securely and at the correct temperature recommended by the manufacturer. This is to protect people in the home and to make sure that medicines are safe and effective for people. 6 10 13 You must ensure staff work 31/08/2010 in a way that respects the privacy and dignity of people who use the service including ensuring the language used by the staff to refer to people who use the service is appropriate. This promotes privacy and dignity. Care Homes for Older People Page 13 of 20 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 7 12 18 You must ensure that all staff 31/08/2010 consult with people living at the home about their social interests and make arrangements to enable them to engage in a range of activities according to their ability. This includes people less able and those spending considerable time in their bedrooms. This will ensure that everyone living at the home will have a good quality of life and be able to participate in things they enjoy. 8 19 23 You must ensure that the 31/08/2010 premises both inside and outside is suitable for the purpose of achieving the aims and objectives set out in the statement of purpose, and are appropriate to the needs of the people using this service. This will ensure that people live in a well mainitained building that is appropriate to their individual needs. 9 29 19 No person must be employed 30/06/2009 in the care home before all the required checks and references have been received and are satisfactory. These include a check against the Protection of Vulnerable Adults list, a Criminal Records Bureau check and a full employment history. If a person is Page 14 of 20 Care Homes for Older People Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action employed in the home prior to receiving a satisfactory check from the Criminal Records Bureau, this person must be supervised by a designated staff member at times, and must not escort people who live in the home away from the premises. This is to ensure that suitable people are employed and protect the people who live in the home from risk of harm. 10 29 17 Personnel files for all staff members must be kept in the care home and be available for inspection. This is to ensure that suitable people are employed and protect the people who live in the home from risk of harm. 11 31 12 You must ensure that the 29/09/2010 home is managed in such a way that proper provision is made for the health, welfare and safety of the people who use this service. This is to ensure that anyone with managerial responsibilty knows what their role and responsibilites of what they must do and can carry out thier duties. 30/06/2009 Care Homes for Older People Page 15 of 20 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 19 13 All parts of the home to 08/10/2010 which the people who use this service have access are so far as reasonably practical free from hazards to their safety; and unnecessary risks to the health or safety of the which the people who use this service are identified and so far as possible eliminated. This is to ensure that people are kept safe from harm and injury. 2 29 19 No person must be employed 27/09/2010 in the home before all required checks and references have been completed and are satisfactory. These include a check with the Criminal Records Bureau, a full employment history and a check with the Independent Safeguarding Authority. This is to ensure that everyone employed to work at the home is fit and suitable to work in a care home. 3 31 17 A record of the position held in the care home, the work performed, and the number of hours employed for every person employed to work in the care home. There must be clarity about roles and responsibilities. 08/10/2010 Care Homes for Older People Page 16 of 20 Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action This will ensure everyone employed to work at Dewi Sant knows their role, the duties they are expected to carry out, and their boundaries. Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 That security of keys, and some medicines in unlocked cupboards and the refrigerator is reviewed. This is to ensure that all medication is stored securely, for protection of people in the home. 12/11/2010 2 9 13 You must ensure that the number of staff trained to give medication is reviewed to ensure that medication can always be given by trained and competent staff. This is to make sure that people receive their medication at the required times in a safe way 30/11/2010 3 9 13 You must ensure that 26/10/2010 medication is administered to people as prescribed for them and that an accurate record is kept of all Page 17 of 20 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action medication given, including external preparations. This is to make sure that people receive their medication as their doctor has prescribed for them, to ensure their health and welfare. 4 9 13 You must ensure that care 12/11/2010 plans include detailed information for staff about the administration of medicines to people, and risk assessments where people manage their own medicines. This is a repeated requirement. The original timescale of 20/08/10 has not been met. This is to make sure people receive their medicines correctly and safely, in the way their doctor has prescribed. 5 37 12 You must ensure that 15/10/2010 peoples rights and best interests are safeguarded by the homes record keeping policies and procedures. This will ensure that all personal and confidential information is secure, up to date and in good order, and meets all statutory requirements that protect peoples privacy and dignity. Care Homes for Older People Page 18 of 20 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 9 It is recommended that all handwritten entries and amendments on medication charts are checked and signed by 2 members of trained staff. This is to reduce the risks of errors occurring and to ensure medicines are given as prescribed. Care Homes for Older People Page 19 of 20 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 20 of 20 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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