Care Home: Grove House

What the care home does well The home is modern and purpose built which is bright and is decorated and furnished to a good standard. All bedrooms are for single occupancy and are provided with en-suite facilities, including a shower. A number of communal areas provide service users with a choice of where they spend their day. What has improved since the last inspection? Assessments and care records continue to improve and full details of the care required by and afforded to service users is documented. The home was clean throughout. The garden areas are now bright, pleasant and well maintained and are provided with seating areas. What the care home could do better: The service user guide would benefit from being updated to reflect the services and facilities offered by the home.Medications are not dealt with in a safe manner and places service users at risk. The homes policy and procedure must be followed to ensure the protection of service users. Evidence of social activities enjoyed by service users is inadequate in some cases and there is a lack of evidence that some service users are provided with any stimulation. There is evidence that service users views are not obtained, particularly in relation to personal care provision and ensuring their protection. Individual views and preferences should be recorded and respected. Complaints should be dealt with in a timely manner in accordance with the home`s policy and procedure. Evidence of staff recruitment in accordance with the home`s policy and procedure must be held. Evidence of staff training must be held. The management of records in relation to the safe running of the premises requires to be organised and made available for inspection at all times. CARE HOMES FOR OLDER PEOPLE Emmanuel Christian Care Home Grove House 1 Palm Grove Claughton Prenton Wirral CH43 1TE Lead Inspector Jeanette Fielding Unannounced Inspection 5th June 2007 08:45 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 Emmanuel Christian Care Home DS0000063096.V331850.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. Emmanuel Christian Care Home DS0000063096.V331850.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Emmanuel Christian Care Home Address Grove House 1 Palm Grove Claughton Prenton Wirral CH43 1TE 0151 652 8078 0151 651 2512 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) Four Seasons (Emmanuel Christian Care Home) Ltd Mrs Siobhan Dean Care Home 63 Category(ies) of Dementia (23), Old age, not falling within any registration, with number other category (23) of places Emmanuel Christian Care Home DS0000063096.V331850.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home may from time to time admit persons from the ages sixty years to sixty five years of age. 17 Intermediate Care beds aged 50 years and over Date of last inspection 20th December 2006 Brief Description of the Service: Grove House is part of the Emmanuel Care Centre located in a residential area in Birkenhead, Wirral. The home is owned by Four Seasons (Emmanuel Care Home) Ltd. The home is registered to provide long term nursing care for up to 46 elderly persons and intermediate care for up to 17 persons. All service users are accommodated in single bedrooms, each having en-suite facilities. A number of lounges and seating areas are provided to enable service users to choose where they spend their day. Service users accommodated for intermediate care have a greater input from Occupational and Physiotherapists to provide them with the skills to enable them to return home following hospitalisation and are accommodated at the home for a period of up to six weeks. The ground floor provides for 17 persons requiring Intermediate Care. The first floor provides nursing care for 23 persons who have dementia, and the second floor provides for 23 elderly persons who require general nursing care. Fees are £445 per week for nursing care and £550 per week for EMI care plus the assessed nursing care fee. Emmanuel Christian Care Home DS0000063096.V331850.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was planned to take place over two days but the disorganisation of some of the record keeping required a third visit to be made to give the home the opportunity to make some records available. A total of 20 inspector hours were spent in the home on 5th, 6th and 11th June 2007. The medications were inspected by a pharmacy inspector to evaluate the safety of the medications administered to service users. Records relating to the care required by and afforded to service users were inspected and discussions took place with service users and visitors to obtain their views of the home and of the care provided. Care records were found to be improved, however, there was some difficulty, initially, encountered by the home in accessing some of the safety records. All areas of the home were decorated and furnished to a good standard and the home was clean and well maintained. Staff were observed when they were working in the communal areas with service users and it was evident that improvements in care practices have been made. What the service does well: What has improved since the last inspection? What they could do better: The service user guide would benefit from being updated to reflect the services and facilities offered by the home. Emmanuel Christian Care Home DS0000063096.V331850.R01.S.doc Version 5.2 Page 6 Medications are not dealt with in a safe manner and places service users at risk. The homes policy and procedure must be followed to ensure the protection of service users. Evidence of social activities enjoyed by service users is inadequate in some cases and there is a lack of evidence that some service users are provided with any stimulation. There is evidence that service users views are not obtained, particularly in relation to personal care provision and ensuring their protection. Individual views and preferences should be recorded and respected. Complaints should be dealt with in a timely manner in accordance with the home’s policy and procedure. Evidence of staff recruitment in accordance with the home’s policy and procedure must be held. Evidence of staff training must be held. The management of records in relation to the safe running of the premises requires to be organised and made available for inspection at all times. 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. Emmanuel Christian Care Home DS0000063096.V331850.R01.S.doc Version 5.2 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 Emmanuel Christian Care Home DS0000063096.V331850.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 6. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Potential service users have access to sufficient information to enable them to make a decision regarding their care provider. EVIDENCE: The Statement of Purpose has been reviewed and is now a detailed and comprehensive document. It is available to view in the foyer of the home. The service user guide has not yet been updated to reflect the changes that have taken place within the home. The General Manager stated that plans are in place to review this document. Copies of the service user guide were seen in service users bedrooms and further copies are available from the home on request. Emmanuel Christian Care Home DS0000063096.V331850.R01.S.doc Version 5.2 Page 9 The care files of eleven service users were inspected who were accommodated for both intermediate and long term care. Pre admission assessments were in place and were sufficiently detailed to allow a plan of care to be prepared. Information is obtained regarding service users medical, social and personal care needs together with any specialist equipment or dietary requirements. Little evidence is recorded as to the persons involved in the assessments, particularly where service users are unable to give information due to their medical or mental condition. Assessments are undertaken by physiotherapists and occupational therapists for those service users who are accommodated for intermediate care. The assessments give full details of the service users needs and identifies an achievable outcome for the service user to enable them to return home with sufficient skills to assist them to live independently. Emmanuel Christian Care Home DS0000063096.V331850.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home has failed to improve their procedures administering medication placing some service users at risk and harm. EVIDENCE: Care plans are in place for all service users. A total of eleven care files were inspected and all were found to contain appropriate risk assessments, risk management strategies and plans for specific care. Ground floor. The care plans on this floor were generally very good. There is occasionally a duplication of risk assessments and plans as these are made by the nurses, with separate risk assessments and plans prepared by both physiotherapists and occupational therapists. Emmanuel Christian Care Home DS0000063096.V331850.R01.S.doc Version 5.2 Page 11 It was evident that all staff work well as a team and consideration should be given to incorporating the needs identified by the multi disciplinary team members to be incorporated into one plan where possible i.e. mobility. The file of one service user states, on the day of admission, that the GP should be contacted for a review of medications, but this was not done until five days had passed. Care must be taken to ensure that all identified needs are acted on in a timely manner. First floor. The care files on this floor were less organised than those in other areas of the home. The company has provided staff with a specific index for files to ensure that information is easily accessible, but were not in place for this unit. The service users on this unit are accommodated for nursing care due to their dementia, but there continues to be a lack of information regarding the way in which their dementia is displayed. There is a lack of evidence of social stimulation and activities as many of the service users have not participated in the activities organised by the activities co-ordinator. No record is held of the one to one time spent by care staff. Second floor. The care files on this floor were organised and all care needs had been identified with care management plans in place. Three files were inspected in depth and were found to be detailed and provided evidence of the actual care given to service users. All files were found to contain risk assessments and risk management plans. Care plans gave staff sufficient information to enable them to provide the appropriate level of care required by each individual service user. Daily reports completed by the staff, were informative and, provided evidence of the actual care given. Medications were inspected by Maggy Howells who is a Pharmacy Inspector. All medication was stored securely, however the standards of handling, recording and administration of medication differed in the three units inspected. Medicines management on the intermediate care unit was good. Some areas where improvement is needed were noted on the second floor unit, but there were serious concerns about aspects of medicines management on the first floor unit. There was an effective system of auditing medication on the intermediate care unit. Once or twice this had highlighted discrepancies, but staff had been open and honest about shortfalls and had taken appropriate action to improve. This is seen as good practice. Whilst the other two units had similar audits in place, they were not being used as effectively, meaning that discrepancies and poor practice had not been identified. Emmanuel Christian Care Home DS0000063096.V331850.R01.S.doc Version 5.2 Page 12 On the first floor, completed audits suggested that all medication had been administered correctly and were accounted for. Evidence was seen, however, that discrepancies were noted at the time of audit, but no action taken to investigate or rectify them. The unit managers should check Medication Administration Record charts (MARs) against current stocks and make sure that all stock can be accounted for. It was suggested that the number of tablets and other medications ‘brought forward’ from the previous month be recorded in order to make auditing easier. This information was not recorded on the first floor unit and sometimes missed on the second floor unit. This meant that it was not always possible to see whether or not medication had been given correctly. Evidence was seen that not all residents received their medication as prescribed. A sample audit of MARs and current stock showed 6 examples of medication that had been signed for as administered but had not actually been given. There were 5 examples where medication could not be accounted for. One resident on the second floor unit had been given the wrong dose of medication for two days because a dose change had not been recorded clearly. Not all medication administered on the morning of the visit had been signed for on the first floor. The health and wellbeing of residents is at risk of harm if medication is not administered correctly and recorded accurately. Monitoring and risk assessments were in place, where appropriate, on the intermediate care unit to ensure that residents were able to self-medicate safely before being discharged. This is essential for the health and wellbeing of residents returning to care for themselves at home. Insulin in current use was stored in the refrigerator, against manufacturers’ guidance. On the second floor, insulin was still being used although it was 9 days out of date. The maximum/minimum temperatures of the first floor fridge were not recorded accurately each day. The health and wellbeing of residents is at risk of harm if medication has been stored at the incorrect temperature or used after the expiry date. Staff did not always have enough information to administer medication safely. Medicines that were only to be used ‘when required’ did not have clear instructions that were personalised to the needs, signs and symptoms of the individual resident. This information is particularly important for residents who have communication problems and those who are given medication covertly. Where variable doses were prescribed, the actual dose administered was not always clearly recorded. The health and wellbeing of residents is at risk of harm if staff do not have clear instructions about administering medication. Records of medication entering and leaving the premises were not always complete. This was particularly noticeable on the second floor unit where a number of residents spent periods of time away from the home. Emmanuel Christian Care Home DS0000063096.V331850.R01.S.doc Version 5.2 Page 13 Accurate records are needed in order to account for medication administered within the home and also to monitor compliance whilst away. One resident who had gone out for the afternoon had not been given medication to take whilst out, nor had it been given on his return to the home. Arrangements must be made to ensure that residents always receive their medication. The handling of Warfarin on the first floor was of particular concern. Warfarin is a potent medicine that can cause serious harm to health if given incorrectly. One resident had only recently been prescribed Warfarin. An audit of current stocks, MARs and other records showed that the medication had been given incorrectly on at least eight of the thirteen days of treatment so far. Furthermore it was not possible to confirm the dose prescribed following the most recent blood test. Another resident was found to have medication missing that could not be accounted for. The health and wellbeing of these residents is at significant risk of harm. During the inspection, service users were spoken to in order to obtain their views of the home. Questionnaires were issued to a number of service users to gather further information regarding the home and gave the opportunity for service users to express their opinions. Comments made by service users during discussion were very positive, particularly from those who were accommodated for intermediate care. They spoke very highly of the staff and of the care and support that they were given. Comments in the questionnaires were also generally positive. One respondent commented on the food and the fact that it was not always sufficiently hot. One respondent commented on the failure of the laundry to attend to clothing with care, resulting in some underwear remaining stained and occasionally damaged. Name tapes had come off the clothing during the laundering process resulting in clothing going missing. Service users and relatives confirmed that service users were treated with respect and dignity and stated that privacy was respected at all times. Emmanuel Christian Care Home DS0000063096.V331850.R01.S.doc Version 5.2 Page 14 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 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Appropriate hygiene and safety measures are to be put in place to ensure that service users meals are prepared within a safe environment and to prevent the risk of contamination which may place them at risk. EVIDENCE: Service users spoken to during the course of the inspection had different views with regard to their expectations and the service provided. Those service users who were accommodated for intermediate care said that the routines within the home were acceptable, but said that they were happy to conform to whatever the home requested of them as they were only there for a short time. They confirmed that time was spent doing exercises with the physiotherapists together with individual therapies to give them the skills to return home. Emmanuel Christian Care Home DS0000063096.V331850.R01.S.doc Version 5.2 Page 15 Service users who were accommodated for long term care were less enthusiastic. One service user made it quite clear that he did not want to be in the home, but appreciated that he was no longer able to cope at home. He did not participate in any of the social activities and could not identify any particular activity that he would enjoy. One service user said that he just liked to watch television and spent a lot of time in his room because the television in the lounge was never on the channel that he liked to watch. The home employs activities co-ordinators who keep a record of the individual activities that are organised. Some files make a high number of references to service users who do not wish to participate in anything, but discussion with staff confirmed that they spent time with the service users on a one to one basis. No record is held of these interactions. Service users who were accommodated for care due to their dementia were unable to express their views on the home or of the activities that take place. One incident was observed on the third day of the inspection, as detailed in section 16-18 of this report which would indicate that service users are not assisted to take control of their lives or to have their choices respected. Visitors are welcome to visit at any time and two relatives confirmed that they visited regularly and liked to be involved with the care of their relatives. One assisted with feeding lunch. Details of forthcoming activities are displayed on notice boards throughout the home. Ministers of religion visit the home on a regular basis and provide services for those service users who request this. The home offers a four-week rotating menu which is regularly reviewed. A choice of meals is offered. Service users are encouraged to take their meal in the dining rooms but can take their meal in the privacy of their bedroom if they wish. The menus provide evidence that a varied and balanced diet is offered to all service users. Special diets can be provided on the advice of or on the recommendation of the dietician or GP. Individual preferences are respected. Some cups in the dining room were found to be stained and require a thorough cleaning. Meals are prepared in the main kitchen and are served individually from heated trolleys. The meals are served by the care staff and the presentation of the plated meal is very dependent on the person who plates the meal. Some meals were attractively presented but some were not. Emmanuel Christian Care Home DS0000063096.V331850.R01.S.doc Version 5.2 Page 16 One family member commented that the food was not always hot and the soft diets were bland and boring. One service user spoken said that they did not really enjoy the meals. The main kitchen was clean and organised. The rear door to the kitchen was found to be open, giving access to another door leading to the outside of the home which was also open. The interim area between the two doors is the area where laundry is taken outside to the laundry facilities in the adjacent home. No fly screens were fitted to either door and has the potential for allowing dust and flies to enter the kitchen area. Fly screens are fitted to all opening windows in the kitchen. Some of the equipment within the kitchen had faults and was not available for use. The waste disposal unit, the deep fat fryer, two hot trolleys and one socket for the heated trolleys were not functioning. The socket on the wall where the faulty heated trolley is plugged in is showing signs of heat damage and should be replaced. The trolley should be PAT’s tested when repaired and evidence of this held in the home. All faulty equipment should be withdrawn from service, repaired and tested and certified as safe to use. Emmanuel Christian Care Home DS0000063096.V331850.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 and 18. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Policies and procedures for dealing with complaints have not been adhered to with some evidence those relatives expressing their concerns that they have not been adequately listened to. There was a lack of evidence to demonstrate that the home has a clear understanding of abuse which places service users at risk. EVIDENCE: The company which owns the home has produced a comprehensive complaints procedure which is detailed in the service user guide and is also displayed on notice boards within the home. The procedure gives service users and visitors to the home full information on how to make a complaint and to whom the complaint should be directed. Four complaints have been received by the home, two of which have been referred to CSCI by the complainants who are not satisfied with the outcome of the home’s investigation into their complaints. There is evidence that the complaints procedure was not adhered to by the home in these two cases with respect to timescales for completing the investigations. Emmanuel Christian Care Home DS0000063096.V331850.R01.S.doc Version 5.2 Page 18 Staff training continues to ensure that all staff are fully aware of adult protection issues and of the action to be taken in the event of this being suspected. On the third day of the inspection, an incident involving a safety and protection issue for a service user raised deep concerns regarding the understanding and implementation of appropriate adult protection procedures. This issue has been discussed in some depth with the provider who has given reassurances that this incident will be the subject of immediate management intervention and remedial action. Emmanuel Christian Care Home DS0000063096.V331850.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 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is bright, clean and welcoming to provide service users with a pleasant environment in which to live. EVIDENCE: Grove House is a purpose built care home located within the Emmanuel Care Home Centre. It is located close to shops and parks and is accessible by public transport. Car parking facilities are provided. The home is on three floors with all areas being accessible by a passenger lift. All service users are provided with a single bedroom, each having en-suite facilities. All en-suites facilities are provided with a shower. Additional toilets Emmanuel Christian Care Home DS0000063096.V331850.R01.S.doc Version 5.2 Page 20 are provided throughout the building together with additional bath and shower rooms. A number of lounges and dining facilities are provided. All areas of the home were found to be clean and well maintained. Bedrooms are furnished and decorated to a good standard and it is evident that staff and relatives have personalised the rooms to reflect service users individual choices and lifestyles. Improvements have been made to provide a more homely environment within lounges to further improve the facilities for service users. Improvements have been made within the garden areas with the provision of raised flower beds and seating areas. The gardens now provide a pleasant area for service users and their relatives. All areas throughout the home were found to be clean and no unpleasant odours were noted. Emmanuel Christian Care Home DS0000063096.V331850.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 adequate. This judgement has been made using available evidence including a visit to this service. Records to demonstrate that staff have been given appropriate training were incomplete which has the potential for service users not being given the appropriate level of care. EVIDENCE: The home employs qualified nurses and care assistants to provide for the service users needs. A programme of recruitment has recently taken place and has proved successful in employing a number of new staff. The staff files were inspected on the second day of the inspection but were found to be poorly maintained with little evidence of essential documentation to demonstrate that the home had obtained sufficient information to ensure the safety of service users. Assurances were given that appropriate checks had been made on staff and so an appointment was made for a third visit to be made to the home to enable the home to produce the documentation. At this third visit, the home was able to produce records indicating that CRB and POVA checks had been made on staff. Little information was recorded regarding the staff interviews and so it was not possible to verify issues discussed. Emmanuel Christian Care Home DS0000063096.V331850.R01.S.doc Version 5.2 Page 22 Some of the training evidence was extremely disorganised, despite the home being given the opportunity to provide this. Induction training is given to all staff but the records of this training are not held on the staff files. These are held separately and proved difficult to ensure the competency of the staff without sorting through a large bundle of paperwork. One member of staff had been recruited having provided a three year old school reference and a testimonial. Appropriate and current references should be obtained, including one from the present or last employer. The pre-inspection questionnaire, which is sent to the home prior to the inspection, had not been adequately completed. The section requesting information on training given to staff had not been completed. It was not possible therefore, without recourse to individual files, to ascertain that staff had completed essential and relevant training to enable them to meet the needs of the service users. The staff rotas show that the home is staffed as required. Unit managers have been appointed with one allocated to each floor of the home. There is evidence that these appointments have been successful in improving the standard of care and documentation within the units. Emmanuel Christian Care Home DS0000063096.V331850.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, 37 and 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The management of necessary documentation is disorganised and has the potential for not ensuring that all equipment is safe and thereby placing service users and staff at risk. EVIDENCE: The registered manager of the home is a qualified nurse who has managed Grove House since the home opened. Prior to the inspection, a pre-inspection questionnaire was sent to the home to request information regarding the establishment, policies and procedures, Emmanuel Christian Care Home DS0000063096.V331850.R01.S.doc Version 5.2 Page 24 service users, personnel and details regarding advocates and other healthcare professionals. This questionnaire was not fully completed and so the inspection took longer than necessary, with some information having to be gathered at the time of the inspection. The management of the documentation held in the home in relation to the staff and the establishment were disorganised and chaotic. A third visit to the home was arranged to enable full information to be gathered and made available for inspection. Records relating to safety certificates could not be found due to the disorganisation of the record keeping on the second visit, but were made available for the third visit. Evidence was made available to demonstrate that all equipment within the home had been checked and approved as safe for use. It was evident that improvements had been made in the care provision for service users. The home does not manage service users personal monies although a service users bank account holds small amounts to cover the costs of hairdressing and chiropody. Relatives and advocates are encouraged to deal with service users finances. Staff supervision records are held by the manager but show that supervision for some staff is sporadic. Annual appraisals are not undertaken on all staff although assurances were given that work is taking place to implement this. There was a lack of evidence to demonstrate that service users rights and best interests are safeguarded by the homes record keeping, policies and procedures due to the disorganisation within the records management systems. Emmanuel Christian Care Home DS0000063096.V331850.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 2 X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 1 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X 3 X X 1 Emmanuel Christian Care Home DS0000063096.V331850.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13(2) Timescale for action Staff must administer medication 06/07/07 in accordance with the prescribers’ instructions so that people who use the service receive the correct amount of medication at all times. Arrangements must be made for residents who spend time away from the home so that they are not left without medication. Full and accurate records of all 06/07/07 medicines received, administered and leaving the care of the home must be maintained to ensure people are given the correct medication. There must be a full record of all medication and doses currently prescribed for each resident. There must be an effective system in place to audit medicines management within the service in order to ensure that people who use this service are receiving the correct medication. 06/07/07 Requirement 2. OP9 17(1) Sch 3 3. OP9 24 Emmanuel Christian Care Home DS0000063096.V331850.R01.S.doc Version 5.2 Page 27 4. OP14 12 (3) The registered person must ensure that the home is conducted so as to maximise service users’ capacity to exercise personal autonomy and choice and ensure that staff respect these. The registered person must ensure that all complaints are dealt with appropriately and in a timely manner. The registered person must ensure that service users are safeguarded from physical, financial or material, psychological or abuse through deliberate intent, negligence or ignorance, in accordance with written policies. 06/07/07 5. OP16 22 31/07/07 6. OP18 OP28 12 (1-5) 06/07/07 7. OP29 18 The registered must ensure that 31/07/07 staff are recruited in line with the homes’ policy and procedure. This remains outstanding from previous inspections. The registered person must ensure so far as is reasonably practicable the health, safety and welfare of service users and staff. 06/07/07 8. OP38 12 23 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. Refer to Standard OP1 Good Practice Recommendations The service user guide would benefit from review and DS0000063096.V331850.R01.S.doc Version 5.2 Page 28 Emmanuel Christian Care Home 2. OP9 updating to more clearly reflect the services and facilities provided by the home. Dose changes should be clearly recorded and signed by two members of staff, so that residents receive the correct dose of medication. Where possible, changes should be confirmed in writing by the prescriber. There should be clear, personalised directions for the use and administration of when required and variable dose medication for all service users prescribed such items. When required and variable dose medicines should also be included in the residents care plan. The opening date should be recorded on insulin, eye drops and other items with a short expiry date. Medication requiring refrigerated storage should be stored in a dedicated medication fridge. The fridge temperature should be maintained between 2-8°C Current stock levels or brought forward quantities should be recorded in order to effectively audit medication. Evidence of activities enjoyed by service users, including one to one time, should be recorded to provide evidence that social interaction is provided. The records management in the home would benefit from review and updating and being maintained effectively. 3. OP12 4. OP31 Emmanuel Christian Care Home DS0000063096.V331850.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Emmanuel Christian Care Home DS0000063096.V331850.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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