Care Home: Karistos

What the care home does well This is a random inspection and therefore not all of the key standards were assessed. A new shower chair had been purchased so that people have equipment that is safe and clean to use. What the care home could do better: This is a random inspection and therefore not all of the key standards were assessed. Staff should ensure that they follow guidance regarding changing people`s position to minimise the risk of sore skin. Nurses should record the reasons for administering `as required` medications so that people receive medication for the reasons prescribed. People must be supported to enjoy the activities that they enjoy without this affecting other people who live in the home. The water drainage in the shower room should be reviewed to ensure that risks to people are minimised. Staff should have the knowledge and skills to manage peoples difficult behaviour. Systems should be in place to ensure that agency staff are given all the information they need to know about the home and the people who live there. Random inspection report Care homes for adults (18-65 years) Name: Address: Karistos 29 Chantry Road Moseley Birmingham West Midlands B13 8DL zero star poor service 02/06/2010 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: Lisa Evitts Date: 0 7 1 0 2 0 1 0 Information about the care home Name of care home: Address: Karistos 29 Chantry Road Moseley Birmingham West Midlands B13 8DL 01214424794 01214424794 karistosnh@yahoo.co.uk www.karistos.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Gursharn Singh Surdhar,Mr Surjit Singh Surdhar,Dr Harminderjeet Singh Surdhar Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 17 Number of places (if applicable): Under 65 Over 65 0 physical disability Conditions of registration: 17 The maximum number of service users who can be accommodated is: 17 The registered person may provide the following category of service only: Care Home with Nursing (Code N); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Physical disability (PD) 17 Date of last inspection Brief description of the care home Karistos Nursing Home has 17 beds and is registered to provide care to younger adults for reason of physical disability. The home is situated in Moseley and is within short Care Homes for Adults (18-65 years) Page 2 of 10 0 2 0 6 2 0 1 0 Brief description of the care home walking distance of shops and bus routes. There is one car parking space at the home, other cars would need to be parked on the road at the front of the building. It is a large three storey converted house and bedrooms are available on all floors. A passenger lift provides access to all floors of the building. There is a lounge and separate dining room. The accommodation consists of four shared bedrooms; nine single bedrooms and two have en-suite shower facilities. Wheelchair access and a platform lift have been provided to the front of the building, as the steps are rather steep. There is a garden to the rear of the home with a small patio area, which is accessible via the dining room. However, the incline to the garden makes it difficult for people to use it. Corridors in the home are narrow and do not provide easy access for people who may require assistance with their mobility. There is a shower room and assisted bathing facility to meet the needs of the people living in the home. The home has three hoists to assist people with mobility problems and has specialist mattresses to help prevent peoples skin from becoming sore. Information is available about the services and facilities on entering the home and this includes a copy of the most recent inspection report, for anyone who may wish to read this information. Current fee rates range from £500 - £800 per week and this information is provided in the service user guide. These fees are reviewed annually. Additional costs include newspapers, hairdressing, clothing and personal effects, chiropody, dentist and optician. Care Homes for Adults (18-65 years) Page 3 of 10 What we found: The focus of this inspection undertaken by the Care Quality Commission (CQC) is upon outcomes for the people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. We last visited the home on a random unannounced visit on the 1st September 2010. Since our last visit Birmingham City Council have told us that they have terminated their contract with the home. This means that they will not pay for people to live there and will help them to find alternative accommodation. This random visit was undertaken by three inspectors over two hours. There were twelve people living at the home on the day of our visit and one of these people was in hospital. The home did not know that we would be visiting. The reason for this visit was to monitor how the home was working towards their improvement plans and to review outcomes for the people living there. During this visit we looked around some parts of the home. We partly looked at two peoples care files and one persons medication. We looked at staff rotas. We spoke to four members of staff and two people who live at the home. The acting manager and one of the providers was present throughout our visit. These are our findings: The provider told us that another manager would be working at the home, in an advisory role. This would be for four days a week commencing the following Monday. The provider told us that this manager had plans to take over the ownership of the home and was submitting an application to us. Until the application is determined, the current providers have the legal responsibility to ensure that the home is run in the best interests of the people who live there. In the lounge we noted that both the television and loud music were on at the same time. This was noisy and disorientating and has been observed at previous visits to the home. The provider told us that it was difficult as some people played up and wanted different things at the same time. The home must review how people can be supported to do the things they enjoy doing without impacting on the lives of other people who live at the home. One person went to the bank with the activity coordinator. Other people were playing card games or had been given newspapers or magazines. One person told us that the paper they had been given was from the previous day. One person did not go out of the home very often. The provider told us that this was because the person swears and plays up when they go out. The provider told us that the person had been assessed and prescribed medication and that they would try to take them out when they were calm. Staff must have the knowledge and skills to be able to manage difficult behaviour. Care Homes for Adults (18-65 years) Page 4 of 10 We looked at one persons care file regarding the management of sore skin. We saw that when a wound was identified, nurses had recorded details of the wound and had written care plans to guide staff. External professional advice had been sought. We saw that generally two hourly changes in position were maintained to reduce the risk of further skin breakdown. Care staff spoken to were able to tell us that the person should have their position changed every two hours and told us that the person should only sit out for two hours for meals and then should go back to bed. Records indicated that the person sat out for two hours in the afternoon. On the day of our visit we observed the person to be sitting in the lounge in the morning. One staff member told us that the person had come down to the lounge at 8am, records stated 9am. We observed the person was still sitting out in the dining room at 12 noon. This means that the person had sat out for longer than the assessed time of two hours. This was brought to the attention of the acting manager and provider at the time of the visit as it means that this persons needs were not being met. We looked at one persons care file regarding difficult to manage behaviour. We saw that medication care plans had not been updated to reflect the recent changes in medication. The person had various PRN (as required) medications prescribed. We looked at the records on the days when the medications had been administered and found that details were limited as to why the medication had been given and sometimes had no reasons at all. On some occasions the records said the person had been agitated but the PRN protocol that had been written said do not give for just agitation. One of these tablets was missing and staff could not account for this. We were told that the person had been given diazepam on one occasion and this had been signed for on the Medication Administration Record (MAR). When we counted the tablets the audit showed that no tablets had been administered as they were all still in the box. We do not know why the MAR sheet had been signed. Staff must have the knowledge about the use of medications and should record why they are giving as prescribed medications. Medication records must be an accurate reflection of the medications administered, so that staff can monitor their effects. We saw in one shower room that the water was not draining away properly and the extractor fan was very noisy. We brought this to the attention of the provider at the time of the visit who told us that he would request the maintenance person to look at this. We saw that the home was generally clean and free from odours. The exception being an offensive odour on the second floor. We saw that the domestic was working on that floor and worked from the ground floor up to the top floor. Therefore this odour was to be addressed. The home currently had one carer vacancy. There appeared to be enough staff on duty to meet the needs of the people living at the home. The provider told us that the home rarely used agency nurses. On the day of our visit an agency nurse was on duty for the whole day. The agency nurse told us that this was the second time they had worked at the home. The nurse told us they had been given a tour of the building and had been introduced to residents. It was concerning that the nurse had not been given any guidance regarding fire procedures. The nurse was not aware that one person living at the home needed their position changed every two hours to minimise sore skin and was not able to tell us about one persons medication. This does not ensure that nurses are being given a detailed handover to ensure that they have the knowledge to meet peoples needs. The management should review how information is passed to staff who do not Care Homes for Adults (18-65 years) Page 5 of 10 work at the home regularly so that they have sufficient information. We saw that some training had been arranged for the staff in the next three months. The training booked is to cover infection control, health and safety, moving and handling, first aid, food hygiene and fire safety. The acting manager told us that agency staff would cover the floor whilst the training took place. This training should refresh and enhance staff knowledge so that they can meet peoples needs. What the care home does well: What they could do better: 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 Adults (18-65 years) Page 6 of 10 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 6 14 Care plans must be updated 07/07/2010 when peoples needs change. So that staff know how to support people. 2 9 13 Risk assessments must contain enough information about how to minimise the risks. So that risks are minimised and people are safe. 07/07/2010 3 16 12 Staff must interact with people who live at the home including people who are unable to verbally communicate. So that people lead an interesting and stimulating lifestyle. 05/07/2010 4 19 12 Ensure that systems are in place. To promote and make proper provision for the health and welfare of service users. 25/06/2010 5 19 12 Make arrangements to 25/06/2010 ensure that staff comply with peoples identified healthcare needs. So that peoples needs are Care Homes for Adults (18-65 years) Page 7 of 10 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 met and people are safe. 6 23 13 Staff must have the 07/07/2010 competence to recognise and respond to potential safeguarding concerns. To protect people from harm. 7 32 18 Staff must have the knowledge and skills to interact with people and know their needs. So that peoples needs are met in a way they prefer that is meaningful. 8 34 19 Robust recruitment systems must in place. To ensure that people are safe from harm. 9 39 12 Systems must be in place to 30/07/2010 identify areas of concern and action taken in a proactive way. To ensure that the home is run in the best interests of the people who live there. 10 42 37 Appropriate authorities must 03/09/2010 be informed of any incidents that may affect peoples health and welfare. So that people are safe from harm. 28/07/2010 07/07/2010 Care Homes for Adults (18-65 years) Page 8 of 10 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 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 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 14 People must be supported to enjoy the activities that they enjoy without this affecting other people who live in the home. Staff should ensure that they follow guidance regarding changing peoples position to minimise the risk of sore skin. Nurses should record the reasons for administering as required medications so that people receive medication for the reasons prescribed. The water drainage in the shower room should be reviewed to ensure that risks to people are minimised. Systems should be in place to ensure that agency staff are given all the information they need to know about the home and the people who live there. 2 3 19 20 4 5 24 33 Care Homes for Adults (18-65 years) Page 9 of 10 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 Adults (18-65 years) 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. 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