Care Home: New Monterey

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What the care home does well The single resident accommodated continues to be very satisfied with the care and support he receives at The New Monterey. The resident continues to have a very good rapport with the home owners and hotel staff and also with a number of the hotel guests who visit on a regular basis. This helps the resident feel comfortable, safe and secure. Meals and menus are to the resident`s satisfaction and he enjoys the company of hotel guests at mealtimes. The single resident continues to enjoy the lifestyle of his choice with the support of the home owners as and when required. What has improved since the last inspection? Since the last inspection one of the home owners has successfully achieved the Registered Manager`s Award. This helps to make sure that this home owner has the skills and understanding to provide the sort of service that the resident wants. As recommended at the last inspection, the resident`s bedroom door has been provided with a lock that suits the needs of the resident. This helps to ensure that the resident`s personal possessions are kept safe.An infection control policy and procedures are now available for staff to follow. This will help to protect the resident from cross infection and help keep him safe. What the care home could do better: There are a number of things that the home owners should do to safeguard the resident. The way medication administration is recorded must be improved to help protect the resident. Policies and procedures must be introduced to protect the financial interests of the resident, along with a clear record of all money transactions with the resident or on behalf of the resident. Whenever a risk is identified, a formal risk assessment should be undertaken. This would help look for ways to eliminate or reduce the risk for the resident and help keep the resident safe. CARE HOMES FOR OLDER PEOPLE New Monterey 20/22 North Promenade St Annes On Sea Lancashire FY8 2NQ Lead Inspector Denise Upton Unannounced Inspection 20th October 2008 1:30pm 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 New Monterey DS0000009910.V372881.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. New Monterey DS0000009910.V372881.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service New Monterey Address 20/22 North Promenade St Annes On Sea Lancashire FY8 2NQ 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) 01253 723392 res@montereybeachhotel.wanadoo.co.uk Mrs Valerie Buckley Mrs Carole Thompson Care Home 3 Category(ies) of Old age, not falling within any other category registration, with number (3) of places New Monterey DS0000009910.V372881.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC, to service users of the following gender: Either; whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP. The maximum number of service users who can be accommodated is: 3. 10th November 2006 Date of last inspection Brief Description of the Service: The New Monterey is a large sea front hotel accommodating, in the main, short stay hotel guests but is also registered to accommodate one older person who does not require nursing care. The hotel is privately owned and the two proprietors provide any support that may be required by the single resident accommodated. No care staff are employed; however, ancillary staff are employed primarily in respect of the hotel, but who also provide a service to the resident in respect of meals. The proprietors have chosen to undertake domestic tasks in the resident’s private accommodation. The hotel is situated within reasonable distance of the main shopping centre of the town and in close proximity of community resources and facilities that the resident can access independently. The resident’s bedroom accommodation is provided with an en-suite facility and located on the ground floor of the building, along with communal facilities that are shared with hotel guests. A passenger lift is provided for ease of access and two ramped accesses are available to the front of the building to enable those with mobility difficulties to gain access. A car park is provided and an extensive raised patio area with tables and seating is available to the front of the hotel that can be enjoyed by the resident in the warmer weather. The current cost of residential care is £255.00 per week. New Monterey DS0000009910.V372881.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that the person who uses this service experiences an adequate quality outcome. This inspection took place during two short periods on different days and in total lasted a period of approximately three hours. Discussion took place with both of the home owners but on different days. In addition, the only resident currently accommodated, who has lived at The New Monterey for a considerable period time, was also fully involved in the inspection. A number of records and policies and procedures were examined and a partial tour of accommodation used by the resident also took place. What the service does well: What has improved since the last inspection? Since the last inspection one of the home owners has successfully achieved the Registered Manager’s Award. This helps to make sure that this home owner has the skills and understanding to provide the sort of service that the resident wants. As recommended at the last inspection, the resident’s bedroom door has been provided with a lock that suits the needs of the resident. This helps to ensure that the resident’s personal possessions are kept safe. New Monterey DS0000009910.V372881.R01.S.doc Version 5.2 Page 6 An infection control policy and procedures are now available for staff to follow. This will help to protect the resident from cross infection and help keep him safe. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. New Monterey DS0000009910.V372881.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 New Monterey DS0000009910.V372881.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): 3. Standard 6 was not assessed, as an intermediate care service is not provided. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The pre-admission assessment form that is used by the home owners to identify what a prospective resident can do well and what help may be required is comprehensive. This ensures that the written information held is in sufficient detail to establish if current strengths, needs, wants and wishes could be met at the home. EVIDENCE: As identified in previous inspection reports, the New Monterey care home accommodates only one resident who was admitted prior to the introduction of the Care Standards Act 2000. New Monterey DS0000009910.V372881.R01.S.doc Version 5.2 Page 9 Although there have been no new admissions to the home since this time, a pre-admission assessment form that is compliant with recommendations is available. However, it is not anticipated that any more residents will be admitted to the home. Recently the home owner requested that the registration be changed and the service has now applied to only accommodate one person. New Monterey DS0000009910.V372881.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 adequate. This judgement has been made using available evidence including a visit to this service. There is a care planning system in place that provides sufficient information to satisfactorily meet the current resident’s needs. The home owners continue to have a good understanding of the resident’s support needs and support is offered in such a way as to promote and protect the resident’s privacy, dignity and independence. Improvements need to be made in the way medication is recorded to make sure that a safe system is in place that protects the resident. EVIDENCE: The plan of care for the single resident is updated as needed. It was evident that when additional support was required this was reflected in the care plan. One of the home owners explained that the care plan is automatically rewritten on an annual basis, in addition to when changes occur, but there was no evidence of a formal monthly review. New Monterey DS0000009910.V372881.R01.S.doc Version 5.2 Page 11 Whilst it is acknowledged that the changing needs of the resident are well known and addressed, nevertheless there is a recommendation that in care homes for older people the care plan is formally reviewed on at least a monthly basis. This does not necessarily mean that the care plan will need to be changed, but there should be evidence of when a formal monthly review takes place. The care plan should also provide details of the medication prescribed for the resident rather than just instruction that staff are to administer the prescribed medication. It is also important that each record is signed and dated by the person making the entry in order to take ownership of the recording and to confirm that an accurate record has been made. The current care plan evidenced had been signed by the resident as acknowledgement and understanding of the content. Some risk assessments are in place, it is understood that these are to be reviewed in the near future. However, the home owner described some other identified risks. Action has been taken to minimise these risks but there was no formal risk assessment in place. Whenever a risk is identified, a formal risk assessment should always be undertaken with signification outcomes incorporated in the care plan. During the course of the site visit a medical professional visited the resident. Although the home owners were quick to summon appropriate medical assistance, this had not been formally recorded, along with outcomes of the consultation. The only evidence available of medical intervention was a hand written note of a GP visit some considerable time ago. It is important that all medical interventions are formally recorded. This could take the form of a chronological record of interventions, consultations and outcomes. This would help to provided evidence that the resident’s medical needs and requirements are fully met as well as providing a clear record of activity and outcomes. It was also noted that the personal detail record of the resident was out of date. This should be reviewed and amended as soon as possible to ensure that accurate and up to date information is always available. Significant improvement is needed to the way medication administration is recorded. At present, although the resident is prescribed three different drugs in the morning, only one set of initials covered the three drug administrations. This is not good practice. Each medication must have an individual signature by the person administrating the medication. It is quite possible that on occasions, only two of the drugs are administered for very valid reasons, however this would not be reflected in the drug administration record. New Monterey DS0000009910.V372881.R01.S.doc Version 5.2 Page 12 The drug administration record is a typed sheet giving the name of the drug to be administered. However, this was not the exact replica of the pharmacist label. There was no dosage or strength of drugs identified and the record had not been signed by the person making the entry or countersigned by a second person to confirm accuracy of the recording. This could pose serious risk for the resident. It is imperative that any hand written entries or typed entries are an exact replica of the pharmacist label, including all details of dose, strength and any special instruction as to when the medication is to be administered. At present, both of the home owners administer medication. One of the home owners has received medication training, the other has not. Given that the resident now requires assistance with the administration of medication, there is an expectation that all staff who administer medication, receive appropriate medication training. It is strongly recommended that the home owner that has not received formal medication training does so as soon as possible. This would ensure that both homeowners understand the importance of accurate recording and help to ensure that the resident is protected. It is also recommended that the name of the person signing the medication record be identified rather than just the initial. This can be achieved by the name and the corresponding initials of each member of staff that administers medication being identified at the front of the medication record. It is understood that the home owners are considering medication being supplied in blister packs. This should help to eliminate some of the current problems with the recording of prescribed medication, however it is essential that the medication in the blister pack be checked against the prescription details prior to administration. The single resident again confirmed that he considered that his privacy and dignity were always promoted and respected. Consultation, as observed during the course of the visit, takes place in the privacy of his individual bedroom accommodation. New Monterey DS0000009910.V372881.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence. including a visit to this service. The home owners have a good understanding of the resident’s support needs. There is a good relationship between the home owners and the resident that includes supporting the resident to access and enjoy social contact. The meals and menus at this home are to a hotel standard, offering a wide variety and choice to the resident. EVIDENCE: The single resident again confirmed that he was very happy living at the New Monterey and stated that his specific needs, wants and wishes, including social activities, were being met. The resident determines his own daily social routines to suit his individual preferences. Leaflets, primarily for hotel guests highlighting local events and places of interest are available in communal areas of the hotel that the resident can access with ease. In addition, when he feels in the mood, the resident continues to enjoy, participating in the programme of activities arranged for hotel guests. A number of hotel guests visit the hotel on a regular basis and the resident enjoys meeting up with these people again and enjoys their company. New Monterey DS0000009910.V372881.R01.S.doc Version 5.2 Page 14 The resident also continues to enjoy the one to one support of the home owners to maintain social contacts and social activities. This includes outings in the local community and walking his dog with one of the home owners and her dog along the beach. This is an activity that is very much enjoyed. The resident’s dog is very important to him and every effort is made to ensure that the needs of the dog, as well as the needs of the resident, are met to ensure that the close relationship is maintained. Although the resident does have family that visit, they live some distance away and therefore can only visit infrequently. In consequence, in the main, it is the home owners and the staff at the hotel who provide emotional and psychological support. This was clearly demonstrated during the course of the site visit. The resident was seen to be very comfortable with all members of staff and said they were like his family. The single resident is encouraged to remain financially independent. Advocacy services are available should the resident wish to obtain independent advice or assistance. It was clearly evident that the resident has important personal possessions in his bedroom to make his personal accommodation more homely. The resident’s dog also occupies the bedroom. This is very important for the resident and shows that the wants and wishes of the resident are respected. The single resident continues to enjoy a wide variety of meals from the hotel menu for breakfast and evening dinner and chooses to eat in the main dining room with hotel guests. The lunchtime meal is of the resident’s choice and usually consists of a snack type meal. In addition, drinks and snacks are available at any time, as observed during the course of inspection. Although the current resident has no dietary needs or requirements, it is understood that a specialist diet with regard to medical need could be accommodated if required. New Monterey DS0000009910.V372881.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The home has a satisfactory complaints system and there is clear evidence that the resident accommodated has his views listened to and acted upon. Arrangements for protecting residents from abuse are in place in order to prevent risk of harm or abuse. However, further policies should be developed especially regarding residents’ monies to reinforce the informal procedure that is in place. EVIDENCE: No complaint has been made for a considerable period of time. The single resident consistently says that he never has anything to complain about but is well aware of whom to speak with if he did have any concerns. There is a formal complaints procedure that is compliant with requirements and recommendations that is incorporated in the home’s Statement of Purpose and Service User Guide. The single resident has been provided with an individual copy of the Service User Guide. New Monterey DS0000009910.V372881.R01.S.doc Version 5.2 Page 16 There is also available an adult protection policy and procedure that is also compliant with requirements and recommendations. There have been no adult protection issues. Policies and procedures are also available in respect of physical aggression and gifts and wills but further policies should be developed regarding service users’ money and financial affairs, the safe storage of monies and valuables and advice on personal insurance. This recommendation has been identified in previously inspections and should be addressed. One of the home owners has undertaken an adult protection training course through alternative employment. This helps to protect the single resident from abuse. New Monterey DS0000009910.V372881.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The standard of the environment is good and meets the needs and requirements if the current resident. However, whilst the environment is attractive and welcoming, it is predominantly a large seaside hotel accommodating short-term holiday guests rather than providing a homely and permanent environment for older people who require a degree of care. EVIDENCE: As identified in previous reports, although the New Monterey is a large residential hotel and public rooms reflect the requirements of hotel guests rather than providing a homely, domestic type environment, it suits the needs and requirements of the single resident at this present time. New Monterey DS0000009910.V372881.R01.S.doc Version 5.2 Page 18 There is a car park and large patio area to the front of the building that is provided with tables, seating and umbrellas in the summer months and a ramped access enables ease of access. It is evident that a programme of routine maintenance and redecoration is maintained and the property now complies with current requirements of the Fire Service and Environmental Health Department. In the last inspection report, there was a recommendation that an appropriate lock be provided to the resident’s bedroom door to enable the door to be opened quickly, by staff in the event of an emergency. This has now been done. The resident’s bedroom meets his current needs and provides an en-suite facility. The resident stated he was very satisfied with his bedroom accommodation. In the past, the resident had refused to have a thermostatic device fitted to control the temperature of the hot water delivered from the hot water tap. At that time, a risk assessment was completed in respect of this matter. However, the resident’s dependency needs and abilities have changed over time. The current lack of a thermostatic device to control the hot water delivered may cause an unnecessary risk for the resident. It is recommended that the situation be kept under constant review and the risk assessment in respect of this matter be kept under very regular review and action taken to minimise any risks identified. Hotel laundry facilities at the New Monterey are located in the basement area of the home, however the single resident’s laundry is laundered in the proprietor’s own private accommodation, rather than the hotel laundry. It is understood that the equipment used is compliant with requirements. As recommended in the last inspection report a policy and procedure has been developed in respect of the control of infection including the safe handling and disposal of clinical waste, dealing with spillages, the provision of protective clothing and hand washing. It is important that all staff read and understand the policy and procedures in order to minimise the risk of cross infection and protect the resident and themselves. New Monterey DS0000009910.V372881.R01.S.doc Version 5.2 Page 19 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): Quality in this outcome area is N/A. This judgement has been made using available evidence, including a visit to this service. None of these standards were assessed, as The New Monterey Hotel does not employ care staff. However, comments have been made in respect of the recruitment process of hotel staff. Although the New Monterey does not employ care staff the registered providers work positively with the single service user to maintain or improve his whole quality of life. EVIDENCE: As identified in previous inspection reports, the New Monterey does not employ care staff, the care needs and domestic care needs of the current resident are provided by the home owners. A structured recruitment process is in place in respect of the cook. This member of staff is predominately employed in respect of the hotel guests but the cook also provides a service to the single service user accommodated. Recently a new cook has been appointed for the hotel. Although a Criminal Records Bureau (CRB) clearance is not required for the cook in this capacity, an ordinary satisfactory CRB clearance must be obtained to fulfil the requirements of the Care Standards Act 2000 as she/he provides a direct service to the resident. New Monterey DS0000009910.V372881.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The home owners are experienced in running a small care home where dependency needs are limited. In consequence, the single resident considers that his current needs and wants are met in full. However, the resident’s financial interests are not always protected. EVIDENCE: Since the last inspection one of the home owners has successfully completed the Registered Manager’s Award. Whilst this was primarily obtained through alternative employment, the skills and knowledge obtained through completion of this course has provided one of the home owners with a greater understanding of the needs of the resident and the running of the care home. New Monterey DS0000009910.V372881.R01.S.doc Version 5.2 Page 21 This is of benefit for the resident and the home owner must be congratulated on her achievement. Quality assurance and quality monitoring systems continue to be based, in the main, on informal daily discussion with the resident. At present, this informal method of quality assurance suits the needs of the current resident and it is clearly evident that the resident continues to be completely satisfied with the services and facilities provided. Since the last inspection, the recording of the resident’s monies and financial affairs has lapsed. At this inspection there was no evidence of any financial records being maintained. The only financial records available were the Local Authority’s residential fees payment details. There is a recently acquired ‘residents’ monies and financial affairs’ policy but this is in very legal terms and not easily understood. The policy also does not incorporate the process of how monies are held in safekeeping at the home or show how the resident is protected. It is essential that any policy and procedure be personalised to the systems in place at the home. There should be clear evidence that the policy and procedures in place are actually put into practice. This could not be evidenced at the time of the site visit. It is understood that the resident receives his personal monies direct into his private account. A percentage of these monies go towards residential care costs and the remainder is the resident’s personal allowance monies. One of the home owners explained that the resident has agreed to some of his personal monies being saved but there is no record maintained of this. In consequence the resident only actually received a proportion of his personal allowance monies. Whilst the resident may have agreed to this, there is no formal agreement in place between the resident and the home owners to give authority to save the money on the resident’s behalf. It is essential that an agreement that is signed by the resident and home owners identifying the terms of the agreement be in place. The content of the agreement should be presented in a way that is easily understood by the resident. There must then be a clear and detailed record of personal monies retained by the resident, monies that are held in safe-keeping on behalf of the resident, monies that are paid by the resident towards residential care fees and receipts of any monies spent on behalf of the resident. (This includes dog food). Wherever possible, the resident and one of the home owners should sign each financial transaction identified on the financial record. There must be a very clear and accurate financial audit trail in place for the protection of the resident’s financial interests. New Monterey DS0000009910.V372881.R01.S.doc Version 5.2 Page 22 From discussion with one of the home owners it is understood that a member of the hotel staff team continues to have direct responsibility for health and safety issues within the hotel that includes the accommodation occupied by the single resident. In the recent past, the Lancashire Fire and Rescue Service expressed concerns about the fire protection systems in the hotel. This resulted in the Lancashire Fire and Rescue service taking legal action and the home owner was fined. Since this time, a complete new fire protection system has been installed in the hotel that meets with current fire regulations. Since the last inspection, as recommended, a new communication, disease and infection control policy has been introduced along with a new health and safety policy. A commercial company has recently completed a risk improvement plan that includes a number of recommendations with target dates for achievement. It is understood that these recommendations are being addressed. One of the home owners has undertaken a variety of health and safety training through alternative employment. This includes manual handling training, first aid training, food hygiene training, infection control training and fire safety training. This helps to ensure that the resident is protected. New Monterey DS0000009910.V372881.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 N/A 28 N/A 29 N/A 30 N/A MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 X X 3 New Monterey DS0000009910.V372881.R01.S.doc Version 5.2 Page 24 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 OP29 Regulation Schedule 2 Requirement The cook who provides a service to the resident must have a satisfactory CRB clearance. (Previous date of 03/04/08 not met). Any financial transactions made on behalf of the resident must be recorded in detail. Any personal monies that the resident has requested be held in safekeeping must be recorded. A formal, signed and dated agreement must be in place between the resident and home owners if an agreed amount of money is held on behalf of the resident by the home owners for a specific reason. There must be a clear and detailed record of personal monies retained by the resident, monies that are held in safekeeping on behalf of the resident, monies that are paid by the resident towards residential care fees and receipts of any monies spent on behalf of the resident. (This includes dog food). DS0000009910.V372881.R01.S.doc Timescale for action 31/10/09 2 3 4 OP35 OP35 OP35 Schedule 4 Schedule 4 Schedule 4 31/12/08 31/12/08 31/12/08 5 OP35 Schedule 4 31/12/08 New Monterey Version 5.2 Page 25 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5. 6 7 8 9 10 11 Refer to Standard OP7 OP7 OP7 OP7 OP7 OP8 OP9 OP9 OP9 OP18 OP19 Good Practice Recommendations There should be evidence of a formal monthly review of the care plan. The care plan should provide details of the prescribed medication of the resident. Each entry on the care plan should be signed and dated by the person making the recording. A formal risk assessment should always be undertaken whenever a risk is identified. Significant outcomes should be incorporated in the care plan. The personal details held in respect of the resident should be updated to reflect current information. All medical profession visits should be recorded, including outcomes of the consultation. Each separate medication that is administered requires the signature of the person administering the administration. All handwritten or typed medication administration records should be the exact replica of the pharmacist label. All handwritten or typed entries on the drug administration record should be signed and countersigned by a second person to ensure accuracy. Policies and procedures should be developed with regard to resident’s monies and financial affairs, the safe storage of personal monies and advice on personal insurance. The current risk assessment with regard to thermostatic devices to control the temperature of hot water outlets in resident accommodation should be kept under constant review. The ‘residents’ monies and financial affairs’ policy and procedures should be written in such a way that it is easy to understand. The policy and procedures should clearly highlight the process the home has in place to protect resident monies held in safekeeping. 12 OP35 New Monterey DS0000009910.V372881.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection NW Regional Office Unit 1, 3rd Floor Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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