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CARE HOMES FOR OLDER PEOPLE

Vishram Ghar

120 Armadale Drive Netherhall Leicester LE5 1HF

Lead Inspector Rajshree Mistry

Unannounced Inspection5th February 2009 09:30

Vishram Ghar DS0000063114.V374103.R01.S.doc Version 5.2

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 Inspection Report Author CSCI Audience General Public Further copies from 0870 240 7535 (telephone order line) Copyright 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

Internet address www.csci.org.uk


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.


SERVICE INFORMATION

Name of service

Vishram Ghar

Address

120 Armadale Drive Netherhall Leicester LE5 1HF

Telephone number

0116 2419584

Fax number

0116 2432745

Email address

[email protected]

Provider Web address

Name of registered provider(s)/company (if applicable)

BestCare Limited

Name of registered manager (if applicable)

Ms Kusum Vala

Type of registration

Care Home

No. of places registered (if applicable)

40

Category(ies) of registration, with number of places

Dementia (40), Mental disorder, excluding learning disability or dementia (40), Old age, not falling within any other category (40), Physical disability (40)


SERVICE INFORMATION

Conditions of registration:

1. The registered person may provide the following categories 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: Old age, not falling within any other category - Code OP Dementia - Code DE Mental Disorder - Code MD Physical Disability - Code PD

2. The maximum number of service users who can be accommodated is 40

Date of last inspection 29th February 2008

Brief Description of the Service:

Vishram Ghar is a care home registered to care for up to forty older persons who may have Dementia, Physical Disabilities or Mental Health issues in an Asian lifestyle environment. The property is purpose built and is situated in the residential area of Netherhall close to shops and other facilities. The home is easily accessible for private and public transport. The home consists of two floors accessible by use of stairs and passenger lift. There are a variety of facilities in the home including dining and lounge space. The majority of bedrooms are single bedrooms, of which two have en-suite facilities and there is one double bedroom. The Registered Manager provided us with the range of fees charged: £338.00 and £385.00 per week, which excludes personal expenditure such as toiletries. People considering using Vishram Ghar are encouraged to contact the home directly. The full details about the home and any specific requirements can be obtained from the home in the form of ‘Statement of Purpose’ and ‘Service User Guide’, which are available in English, Gujarati, Punjabi and can be made available in other languages. The latest Inspection Report from the Commission for Social Care Inspection is available at the home.


SUMMARY

This is an overview of what the inspector found during the inspection. The quality rating for this service s 0 star. This means the people who use this service experience poor quality outcomes. ‘We’ as it appears throughout the Inspection Report refers to the ‘Commission for Social Care Inspection’. This key (main) inspection of Vishram Ghar, started with the review of the last key inspection report dated 29th February 2008. We looked at the information we have about the management of Vishram Ghar, the concerns and the complaints. We received from the Registered Manager the completed Annual Quality Assurance Assessment (AQAA) document, which is the home’s self-assessment of the standards within the home. We sent twenty-two surveys to the people living at the home and their relatives. We sent out surveys in English and in people’s preferred languages that was made known to us: in Gujarati and in Punjabi. We received six surveys from people using the service and three from their relatives. We translated the surveys into English and have included a summary of responses and comments received in the relevant sections of this inspection report. We sent twenty-one surveys to staff, of which two were returned. The responses and comments received have been included in the relevant sections of this inspection report. We sent one survey to the General Practitioner and received their response, which has been included in the relevant sections of this inspection report. We received a number of concerns from the relatives of the people living at Vishram Ghar. Whilst they wanted us to know what the issues were, they were happy to raise these in the first instance with the home directly. We were also notified by the Environmental Health Officer to the risk to people using the service in respect of the closure of the non-vegetarian kitchen due to the poor state of hygiene. We visited Vishram Ghar on 5th February 2009, starting at 9.30am and ending the first day’s visit at 7.30pm. We did this key inspection with an 'Expert by Experience' who spoke to a number of people who are using this service; visiting relatives and staff working at the home. An 'Expert by Experience' is a person who either has a shared experience of using care services or understands how people in this service communicate. They visited the service with us to help us get a picture of what it is like to live in or use the service. This is important because the views and experiences of people who use services are central to helping us make a judgement about the quality of care.


The ‘Expert’ as referred in this inspection report means the ‘Expert by Experience’. Our last day of the site visit was on 12th February 2009, when we met with the visiting Environmental Health Officer. The visit was to establish if the requirements made by the Environmental Health Officer had been addressed and lasted a further 3 hours. The main method of inspection we used was ‘case tracking’. This means looking at the range of care and support needs people received with consideration to their individual cultural and diversity needs. This was done by selecting six people; all having a range of different care needs, levels of independence and lifestyle and included a person on a short stay. We spoke with people using the service and visiting relatives, in their first language. We read their care files containing information about the person and their needs. We made observations throughout the day of the staff and their conduct with the people living at the home. We looked around the home used by people living at the home. We spoke with the staff on duty and looked at the staff recruitment and training records. As part of this key inspection, we looked at the issues of concerns brought to our attention by relatives and through the survey comments. Throughout the day, we shared our observations, findings and concerns with the Registered Manager and the Responsible Individual. The Commission for Social Care Inspection has a focus on Equality and Diversity and issues relating to these are included throughout the main body of this inspection report. What the service does well: Vishram Ghar is a residential care home situated in a residential area. The home offers an ‘Asian Lifestyle’ to suit people from an Asian background, culture or lifestyle. Information about Vishram Ghar is available in various Asian Languages such as Gujarati and Punjabi. Some people have lived at the home for many years and feel it is their home. People are offered a choice of Asian meals that are prepared on the premises. People’s religious and cultural needs are met and respected by the staff. People are able to converse with staff who speak a number of Asian languages and dialects.


Some of the comments received in the surveys from the people using the service, their relatives, the General Practitioner and the staff included: “My wife is unable to speak but I am kept informed always via telephone calls” “We end up talking about the good and bad things about our lives and pass time” “Good variety of Asian food, which the residents and their carers have input in” “All the girls are good” “In the last place everyone spoke English, here I can speak to the girls and they speak to me” What has improved since the last inspection? Since the last inspection of the service, Vishram Ghar has recruited a care worker and a senior carer. An Activity Worker has been recruited and they work three days a week doing activities in small groups and individually. The home has had a ‘Parker Bath’ installed, which is a bath used by people with a physical disability or are not fully mobile. However, this is not available for use. New paperwork and forms have been introduced such as a ‘needs assessment’, ‘care plan’ and ‘complaint form’. What they could do better: Vishram Ghar needs to make significant improvements in all areas to ensure people’s health and care needs are met safely and by trained staff. Vishram Ghar must improve leadership and have robust management systems to oversee the staffing and staff skills, best practice and compliance with regulations and standards, which affects the quality of care and support people receive. Please contact the provider for advice of actions taken in response to this inspection.

The report of this inspection is available from [email protected] or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request.


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


Choice of Home

The intended outcomes for Standards 1 – 6 are:

1. Prospective service users have the information they need to make an informed choice about where to live.

2. Each service user has a written contract/ statement of terms and conditions with the home.

3. No service user moves into the home without having had his/her needs assessed and been assured that these will be met.

4. Service users and their representatives know that the home they enter will meet their needs.

5. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home.

6. 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 and 3. Standard 6 is not applicable. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who may use the service do not in all instances have a comprehensive assessment of their needs undertaken this can effect the care they receive. EVIDENCE: We read the information people receive about the home, known as ‘Service User Guide’ and the ‘Statement of Purpose’, from the Registered Manager. The information provides people with an overview of the facilities, services and the management of the home. It sets out the process of moving into the home, the assessment and the type of care and support people can expect to receive. The complaints procedure is set out clearly and shows how concerns and complaints are addressed. The information is available in a number of Asian languages, such as Gujarati and Punjabi.


We spoke with the people using the service and their visiting relatives in their first language, which were mainly Gujarati and Punjabi. They said their families had found the home for them as it offered an ‘Asian lifestyle’. This means the home caters for people from an Asian culture background. People living at the home told us that they had relied on their families to read the information about the home. The survey responses received from the people living at the home and their relatives confirmed they had received information about the home, which enabled them to make a decision that it was the right home for them. The comments included: “We received the information at the time when we admitted patient to the home. Prior to moving patient to the home, the home was researched on the Internet and read the review on CSCI report” The information we gathered from the self-assessment tool completed by the Registered Manager, told us that individuals and their representatives are encouraged to look around the home to help them decide if it is the right place for them. We wanted to find out if the assessment process helped to identify people’s care needs. We looked at the records of six people who lived at the home; all had had an assessment of their needs carried out by a Social Worker. The Registered Manager told us that they now use the new ‘assessment of needs’ form, to gather details of the person’s care needs. However, the assessments carried out by the staff at the home were not comprehensive, scant account as to the care and health needs of the people, dietary needs, history and family support and information about their expectations of care. Whilst tick boxes used indicated the person’s mobility, sight or mental wellbeing, there was no other information to show how they wish to be supported. The people that we case tracked had been living at the home for different lengths of time. We spoke with a gentleman on a short stay who said his stay was arranged by a social worker. We looked at their care assessment and found they were assessed as ‘confused’ yet he was able to describe to us how he came to the home and his expectations. Another assessment and information gathered by the home contradicted the assessment carried out by the Social Worker; for example, having a ‘mental health’ problem was translated as having a ‘learning disability’. This showed information gathered was not consistent, accurate and may result in care needs not being met. Staff we spoke with told us they are told about any new people moving into the home as part of the handover meetings between staff. This supported the surveys responses from the staff, which included comments such as;


“Communications are made at the end of each shift”. Vishram Ghar does not provide intermediate care services.


Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. The service user’s health, personal and social care needs are set out in

an individual plan of care. 8. Service users’ health care needs are fully met. 9. Service users, where appropriate, are responsible for their own

medication, and are protected by the home’s policies and procedures for dealing with medicines.

10. Service users feel they are treated with respect and their right to privacy is upheld.

11. 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 and 10. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Individual’s care and health needs are not met safely because of poor care planning, care practices and lack of staff that leave people at risk. EVIDENCE: We wanted to find out how individual’s health and care needs were met by the home. The self-assessment tool completed by the Registered Manager stated information gathered from the ‘needs assessment’ is reflected in the new ‘individual care plan’. We received mixed responses in the surveys from people living at the home and their relatives regarding ‘people having a care plan’ and ‘receiving the care and support needed’. The comments received in the surveys and from the people using the service and their visiting relatives, included:


“I was given a care plan in September 2008, but the patient was admitted on 01.03.08” “The care and support is not always promptly done. Most of the time patients are being heard shouting for help” “They are fulfilling the needs but I have to keep reminding them” “On basic personal hygiene and presentation, we had to tell the care home what to do e.g. wash hands and face after meals, when getting her up from her afternoon nap to change her spoilt clothes from afternoon lunch and comb her hair” “Mum’s initial care plan was explained to us but over the two years we have to keep reminding them of mum’s basic personal hygiene and presentation needs” “I always go to the toilet after my food on my own and today, staff were telling me I couldn’t go alone. I now know why they didn’t want me to be on my own, in case I tell you something” “Staff do not have good hygiene practices, you have to tell them to change mother’s clothes and bedding”. We walked around the home and spoke to people individually in their bedrooms and in small groups. Both the Expert and ourselves found people living at the home were reluctant to talk to us when the staff or the Registered Manager was close by. We saw a number of people staying in bed and heard them calling for help. Staff that we spoke to told us “she’s always shouting like that”. Although the member of staff assisted the lady, there is a risk of people developing other health and medical problems if people have to wait a long time for help or remain in wet clothing, which increases the risk of pressure sores developing. The Expert saw a lady slumped in the armchair in the first lounge and appeared to be uncomfortable. She asked to be helped to sit up properly into a more comfortable position. When we raised this with the Registered Manager, she said, “she always sits like that” but had never asked her if she was comfortable. We saw several people had drinks in their rooms, but they were out of reach. On one occasion the Expert assisting us during this site visit had to give a drink to a lady and when the Responsible Individual saw this, called a member of staff to take over. This highlighted that staff are not responding or being vigilant.


‘Fluid and turning charts’ are available in the bedrooms. We checked these charts for several people and we saw that there were gaps between 3 to 11 hours between checks. This shows checks are not taking place at regular intervals. As the Expert and we walked around the home on the ground floor and the first floor, there were strong and offensive smells of urine, especially in the corridors where people stayed in bed. The Expert observed a lady calling staff to be taken to the toilet and then she decided to go herself trying to walk with the walking frame, in wet clothes. We saw other people sitting in the dining room and the lounge showing concern and calling for staff to help the lady and eventually a member of staff responded. This highlighted that staff are not available to respond quickly when people need to use the toilet and increase the risks to their health. (Also refer to section on Environment and Management & Administration in this report). Several visiting relatives that we spoke with said they feel they ‘must come to the home to make sure their relatives personal care and hygiene is carried out properly’. For example, a visiting relative expressed concerns to us that their relative living at the home has fallen out of the bed on a number of occasions and had bruising to the face and arms possibly resulting from the fall. The visiting relative said the General Practitioner was called and the person was taken into hospital. Now the visiting relative said he goes to the home at tea-time to watch how staff assists his relative into bed. The family now are promptly informed of any incidents that occur with their relative living at the home. We raised this with the Registered Manger and advised them to review the full needs of several people living at the home to ensure their needs are being met satisfactorily. The Expert assisting us with this site visit had to ask a member of staff to change her apron as she went from helping with the meals and was about to help a lady with personal care tasks. This showed staff conduct and practice increases risk to people’s health and well-being by unsafe use of protective clothing. We shared the observations made throughout the day with the Registered Manager and the Responsible Individual. Of the number of incidents that we observed; comments received and concerns brought to our attention before this inspection, highlighted concerns about the care practices and whether people’s needs were being met properly. We concluded that there were not sufficient numbers of trained staff on duty to meet the needs of the people, especially as a number of people stayed in bed. We asked the staff if they know what individual’s care needs were and where the care plans were kept. Staff made general comments about how they help some people and said the care plans may be kept in the office. This indicated staff did not know about the care needs fully or the contents in the care plans and therefore, were not fully aware of people’s needs.


We read the care files for the people we case tracked. We saw copies of the comprehensive assessment completed by the social worker, where the person is financially supported. However, the care plans produced by the home that we read, were written in a variety of styles; were old care plans and did not reflect the information gathered from the social worker’s assessment. There was no current information about the daily care and support needs they need with regards to personal care, which includes toileting, bathing/washing, mealtimes and mobility. The care plans did not include any information about preferences, where people have dementia or memory loss, communication needs, poor hearing or eyesight and therefore, there is no guidance for staff, even if they did read the care plan. There were a number of examples of how poor care planning and lack of information and guidance placed people at risk. We saw the care plan that stated the lady has a catheter. However, notes from the District Nurse visits a few days after the lady moved into the home stated that the catheter had been removed, yet the care plan had not been updated. We saw a summary of care needs, which stated “2 hourly checks”, yet the care plan made no reference and the fluid and turning chart kept in the bedroom was not reflective of the 2 hourly checks but had gaps ranging from 3 to 11 hours. We looked at the care file for a person with poor eyesight. The home’s assessment and care plans recently completed by the Registered Manager made no reference to this and how to support them with their daily care needs and safety, even though there is a copy of the social worker’s assessment and care plan detailing this information. In fact, the assessment indicated the person was ‘confused’ and comment written beside the tick box “… has very bad temper, often gets aggressive, swearing and shouting”. This indicates the assessment and care planning used in the home is not robust or accurate. The information gathered from the ‘service user guide’, which people receive stated ‘care plans are reviewed at three levels’. However, our findings on the day from viewing the records clearly showed this is not practiced. Therefore, people are mis-informed about the practices and procedures within the home. In one instance, we saw that the family had written a care plan for the home to follow. This was displayed in the office notice board and shows confidentiality is not maintained. When we asked staff about this particular care plan, they confirmed that the family had made them aware of it. Even though the family had written the care plan, the home’s care plan had not included this into the care planning arrangement. We saw evidence of individual weights being monitored but the last entry was made in May 2008 and no other records were found of weights being monitored. The risk assessments were basic and safety measures were not reflected in the care plans. For example we saw risk assessment stating the person is able to ‘weight-bear on one leg’ but no guidance given to staff. We


saw some evidence that reviews were taking place. However, the changes were not reflected in the care plan. Therefore, we concluded that individual’s personal care needs are not met as care plans are not up to date and staff do not read the care plans. We saw there were a number of people being cared for in bed who appeared to need more health support. Staff told us there were a number of people that had developed pressure sores and were being seen by the District Nurse. This was further evidence that care practices, care planning, lack of awareness and information for staff places people at risk of not having their health and personal care needs met safely. We were told the District Nurse was due to visit but had cancelled due to the heavy snowfall. We were unable to find out when the District Nurse was due to re-visit. The staff we spoke with although were very caring, did not appear to be fully aware of individual care needs, especially in relation to hygiene practices and pressure area care. Staff told us they had received “all the training needed from the manager and the tutor who visits the home”. Staff training records viewed showed staff having received ‘in-house training’ provided by the Registered Manager and using a training programme consisting of a video and completion of a questionnaire. A number of staff told us they are due to start training in ‘infection control’. This indicates that infection control training is not part of the mandatory training and supports some of the concerns raised by the relatives about the hygiene practices in the home. The responses received from the relatives indicated they were usually kept informed about the well-being of their relative including hospital admission. The comments received were: “When accident, fallen out of wheelchair, high temperature have occurred, we are kept informed” “My wife unable to speak but I am kept informed always via telephone calls” The care files did have information to show people received health support from the District Nurse or the General Practitioner, but was not kept in good order. On the first day of our visit, we saw several people being seen by the visiting Optician. Staff were seen supporting people by translating the questions asked by the Optician. We did receive a survey from the local General Practitioner that sees people at the home. The response indicated they were happy with the care provided by the home to the people using the service. The comment received in response to how the service could improve was, “on-going training”. People we spoke with said they felt staff that help them with their personal care respected their privacy and dignity. The comments we received from people included:


“All staff are good – better than at home on my own” “In the last place everyone spoke English, here I can speak to the girls and they speak to me” We saw ladies were wearing traditional dress like saris and Punjabi suits. There were some people that preferred to wear casual western clothes like dresses or jogging tops and trousers. This showed people were supported with their preferred form of dress. We also received a number of concerns from the visiting relatives about clothing going missing or having to wear other people’s clothing. Relatives told us that they have complained and do not get a satisfactory answer from the management team. We saw that a number of bathrooms and toilets were not usable. For example, one toilet was being used to store old wheelchairs. People were using the ‘visitors toilet’ but the lock did not work. A new ‘Parker Bath’ (a bath with a hoist) has been installed for a number of months but is not usable. Staff told us they had not received training as this had to be cancelled due to heavy snowfall. However, when we looked at the bathroom, there were loose electric wires and the tiling and fittings were incomplete. There is a shower room but the shower stool is covered in paint splashes and a bath with a broken bath panel. This indicates the environment is not pleasant or inviting for people to use. A number of people living at the home expressed concerns about having to bathe in cold water, which will affect their health. The liquid soap dispensers were empty and this increases the risk of cross infection with poor access to basic hand washing facilities. This shows that individual’s choice, rights, privacy and independence is not being promoted. (Also refer to the section on Environment in this report) The medication is kept locked in the treatment room, near the office. The medication is prepared into blistered packs by the Pharmacy. The senior carer told us the Registered Manager had trained her to give out medication, having been in post for a few months. The management of medication and the practice to give out and record medication taken was good. We spoke with a number of people in their bedrooms. One lady we spoke with had a number of ‘over the counter’ medication bottles on the windowsill above the radiator. They told us they are always kept the medication there. Whilst people wish to manage their own medication, this should be assessed and they should be provided with lockable facilities.


Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 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.

13. Service users maintain contact with family/ friends/ representatives and the local community as they wish.

14. Service users are helped to exercise choice and control over their lives. 15. 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. The activities offered are limited, not planned or reflective of people’s interests. This inhibits individuals right to choose how to live. Full choice of meals available is not known. EVIDENCE: We wanted to find out what support and opportunities to engage with family, friends and social interest are provided to people using the service. As you enter the home, the foyer is decorated with various statues and images of Hindu Gods and Asian style ornaments. This created a welcoming atmosphere for visitors. There was no information about the social activities, support and opportunities offered to people using the service in the self-assessment tool completed by the Registered Manager or displayed around the home. We walked around the home to see where people were, some were sat in one of two lounges and others remained in their bedrooms. We saw three ladies sitting in the first lounge, watching an Asian programme on the television. People were sat around the perimeter of the lounge, which did not allow people


to talk to each other. There were no pictures or paintings on the wall and there was a cold draught coming from the chimney. In addition, the television lost reception and people continued looking at a blank screen up until lunchtime, despite staff going in and out of the lounge. The second lounge further down the corridor was decorated with pictures on the mantelpiece above the fireplace and had shelving with videos and books in the corner. This lounge was significantly busy with people engaged in conversation, people smiling, one lady was knitting and the others clapped and sang along with the religious songs that were playing. This created a good atmosphere in the lounge. We saw people receiving visitors and spending time in the lounge or in the privacy of their bedrooms. Visiting relatives that we spoke with said they visit everyday to make sure their relatives are safe and well cared for. We observed staff speaking with people using the service in Asian languages. The staff were respectful and used culturally appropriate languages to address people when they were speaking with them. This showed the home did continue to provide an Asian lifestyle that matched people’s culture. The responses and comments received from the people using the service and their relatives and in the surveys indicated that an Activity Worker had been appointment and included the following comments; “There is a staff member who does activities with the patients on a regular basis, There is no activities that family members would be invited to and to join in with the patients”. “Until very recently there were no activities arranged. The TV is left on but there is nothing like exercise or external trips organised. At the moment I am doing one activity this does make me happy but I would like more” “It keeps my hands busy knitting, when there’s nothing to talk about” ”We end up talking about the good and bad things about our lives and pass time” On arrival of the Activity Worker at the home, various people attempted to get her attention as they were excited by her presence and wanted to know what activities they would be doing. We spoke to the Activity Worker who confirmed that people were stimulated in small groups or individually with activities such as board games and conversations or singing religious songs. She said, “there’s limited activities and equipment, I’ve asked for games as people do enjoy snakes and ladders and connect 4”. We received several comments in the surveys suggesting ‘people would enjoy trips out in the summer’.


We looked at the records that showed people participated and engaged in activities of interest to them. Whilst the Activity Worker was recruited to do activities with the people using the service, there was no set days or plans of the activities and she is now required to do care work. Hence, our observation of people asking the Activity Worker what was planned. The care plans read still had no information about individual’s interests. This was an issue raised at the last inspection and has still not been addressed. The Activity Worker told us she has spoken with people living at the home and their relatives to find out about their interests. This shows some initiative had been taken to find out about people’s interests. Vishram Ghar offers people an Asian lifestyle home and provides Asian meals. All the meals are cooked at the home in one of two kitchens: non-vegetarian and vegetarian kitchen. Prior to our visit to the home, we received surveys from people living at the home and their relatives about the meals provided. They made reference to ‘an area having to be cleaned up by them, which staff felt unable to deal with’. The Environment Health Officer informed us that the non-vegetarian kitchen has been closed following their visit on 4th February 2009 due to poor state of hygiene. We saw a notice on the door of the non-vegetarian kitchen reading “closed for 1 month”. Staff, including the cook told us this was due to the ‘gas pilot light’. This indicated staff were not aware of the real reason and therefore may not take steps to improve the practice of good hygiene. The care plans we read had little or no information about people’s preferences of meals. We received mixed comments in the surveys from the people using the service and their relatives. Comments included: “Meals are at a reasonable standard but had to be told and raised in the patients meetings, on what food is preferred by individual patients” “Good variety of Asian food, which the residents and their carers have input in” We wanted to find out the quality and choice of meals served at the home. The choice of menu was displayed in the first dining room, which was written only in English and did not offer people a choice of meat or fish dishes. This indicated that people were not given an option of a meat or fish dish. The Registered Manager said if people requested meat or fish dish, this would be brought in; yet this was not stated in the menu. People had a choice of traditional vegetable curries and lentils, rice, chapatti/roti (flat bread) and served with pickle, salad and poppadoms. The Expert assisting us during the visit observed people that needed assistance with their meals had to wait 45 minutes whilst staff served the meals. They observed two staff feeding people their lunch. Whilst one carer sat face-to-face


and gently encouraged the lady to eat another carer stood over the lady to feed her. This showed the difference in practice that does not show respect or promote people’s well-being. People used two dining rooms, of which the dining room outside the closed non-vegetarian kitchen was cold. The meals were served at the tables by staff. People were continuously being offered extra food and hot chappatis/rotis that were freshly made. We saw staff walking around the dining tables carrying bowls of hot curries, which places people and the staff at risk of spillage or being scalded by hot food if they tripped over. The people sitting in the first dining room appeared to enjoy their meals. However, the people sitting in the cold dining room said “it’s always cold here – heating is here but it’s not turned on; fan heaters does nothing” and “we have to wear warm clothes for lunch and dinner”. The windows were draughty and the radiators had little impact on the freezing temperatures on the day of the visit. Throughout the day we shared our observations and concerns with the Registered Manager and the Responsible Individual. Whilst there were some improvements made with the appointment of an Activity Worker, care practices, management and the lack of communication with staff, does not ensure people’s needs are met safely and do not enjoy the daily living experiences.


Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. Service users and their relatives and friends are confident that their

complaints will be listened to, taken seriously and acted upon. 17. Service users’ legal rights are protected. 18. 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. Complaints are not addressed quickly and the lack of staff awareness to protect people from harm and abuse puts those living at Vishram Ghar at risk. EVIDENCE: We wanted to find out if people were aware of how to make a complaint and what the process was. We did this by sending surveys out to people living at the home and their relatives. We had a mixed response about people knowing how and to whom to complain to, both verbally and in writing. We read the home’s complaints procedure, which is available in various Asian languages. The information we gathered from the self-assessment completed by the Registered Manager stated, “all complaints are taken seriously and are resolved speedily”. It also told us they have a new complaints procedures and forms that are easier to complete. We read the record of complaints received and noted there was one outstanding complaint dating back to July 2008. This was the complaint received by the Commission for Social Care Inspection and referred to the home to investigate, using the home’s complaints procedure. Some visiting relatives that we spoke with told us they have complained verbally but these


were not recorded in the complaints record. This showed all complaints are not recorded. The surveys received also indicated that people have complained verbally and that complaints are not resolved quickly. Comments received included: “All complaints take too long to get sorted” “Answers are received take too long to get it. Quite often the answers from the carers is not satisfactory” “… I have to complain a lot before procedures are put in place” “Most times if we have raised concerns, we do have to remind them again on various occasions” ”We were never given the complaints procedure. However, we have had meeting and written to them regarding incidents that have occurred during the …. years my ….. has been there. One then they have never said to us is if we were no happy with the outcome, who we could go to take the matter further. There have been times when we felt the need to speak to an outside agency without it affecting ….. residency” Both the Expert and we found people living at the home were not willing to talk to us when the staff or the Registered Manager was close by. The comments received varied depending on who was in near to us when we spoke with the visiting relatives or the people using the service, saying they had no complaints. Staff told us they would refer people to raise concerns with the Registered Manager. This indicated that staff appeared not to want to listen to the concerns in the first instance, which could be resolved immediately. This along with the other evidence gathered demonstrated that the home continues to fail in following the home’s own complaints procedures in responding ‘speedily’. We wanted to find out if staff at the home, knew how to deal with allegations made by people living at the home with regards to abuse. Whilst staff we spoke with said they would tell the manager if they had any concerns, they were unable to give examples of the forms of abuse that could occur, including neglect by not responding and meeting people’s care needs. The staff-training matrix showed staff had received training. However, the lack of awareness by staff from our discussion about potential forms of abuse and their role and responsibilities in dealing with allegations, could have a detrimental affect on the welfare of people living at Vishram Ghar.


Environment The intended outcomes for Standards 19 – 26 are: 19. Service users live in a safe, well-maintained environment. 20. Service users have access to safe and comfortable indoor and outdoor

communal facilities. 21. Service users have sufficient and suitable lavatories and washing

facilities. 22. Service users have the specialist equipment they require to maximise

their independence. 23. Service users’ own rooms suit their needs. 24. Service users live in safe, comfortable bedrooms with their own

possessions around them. 25. Service users live in safe, comfortable surroundings. 26. 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, 21, 24, 25 and 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home environment and hygiene practices needs to improve significantly for people living at Vishram Ghar. EVIDENCE: The information we gathered from the self-assessment tool completed by the Registered Manager stated, “refurbishment is complete and we regularly receive positive feedback from a number of people who visit the home” and “full refurbishment has been completed”. We received mixed responses in the surveys received from people living at the home and their relatives regarding the home environment. The comments received included:


“Some areas within the home does require attention, due to unpleasant smells from carpets and rooms …” “The care home is not clean and tidy. A lot of times there is bad smell, carpets are dirty and not cleaned. The cleaning is not done everyday in a hygienic manner” “Hygiene standard is very poor” We also received a comment, from a relative that made reference to ‘an area having to be cleaned up by them as staff felt unable to deal with it’. The Environment Health Officer informed us that the non-vegetarian kitchen has been closed following their visit on 4th February 2009 due to poor state of hygiene. The Environmental Health Officer made a number of requirements and good practice recommendations that included adopting good hygiene practices and regular checks to monitor the cleanliness. The Registered Manager told us the non-vegetarian kitchen would remain closed, for refurbishment and we saw building work continuing on the last day of our visit. We wanted to see the home environment in which people lived from the lounges, bathrooms, to the individual bedrooms. On entering the home, you see religious pictures of Hindu Gods and decorative ornaments. The Expert and we made a number of observations of the standard of accommodation and cleanliness that could be improved to prevent people being at risk. One corridor leads towards the lounges, dining rooms and kitchen had laminated flooring, which was clean. The first lounge where ladies were sat around the perimeter of the lounge watching the television, a draught was coming from the chimney and there were no homely features such as pictures or ornaments. This was in stark contrast to the second lounge, used by a number of ladies, which was filled with conversation creating a busy atmosphere. The seating was arranged in smaller clusters to encourage conversation and the lounge was warmer. There were pictures on the walls and above the fireplace that created a homely feel. The first dining room was warm and light, which created a homely feel. Whilst the non-vegetarian kitchen was closed, people were using the second dining room outside this kitchen, which was cold. The freezing temperatures and the draughty windows further impacted upon this. We saw the fire door was held shut with three bungee ropes. This posed a risk to people in an emergency, as it was the designated ‘fire exit’ in that room. The Fire Officer we spoke with confirmed they were made aware of the state of the fire exit and questioned when the door would be repaired. At our second visit to the service, the fire exit door was repaired and in good working order. As the Expert and we, walked around the home both the ground and first floor, we noticed that there were a number of bathrooms and toilets that were ‘not in


use’. The Expert noticed the skirting boards in all the bathrooms and toilets were ‘dusty and dirty’. People living at the home told us they use the ‘visitors toilet’. When we looked at this, the door was not lockable, which compromises people’s privacy and dignity. The usable bathrooms and toilets had no liquid soap in the soap dispensers and had new bars of soap for use. This practice increases the risk of cross infection. We saw a bath with a broken bath panel and a shower stool covered in paint splashes. This is not inviting for people to use. We saw a new ‘Parker bath’ had been installed in a bathroom. The Registered Manager told us the staff had not yet received training and therefore could not use it. However, the bathroom was not usable as there were loose electric wires and bathrooms fixtures and fittings including the tiling, was incomplete. People living at the home, told us they often have to bathe quickly as the water is cold. The lack of usable number of toilets and bathrooms with appropriate supply of hot water and hand washing facilities places people’s health, hygiene and safety at risk and does not promote independence. The Expert saw the corridor on the first floor was dark despite people going in and out of their bedrooms. However, in the afternoon the corridor was well lit. The corridors to the bedrooms on the ground floor and the first floor had offensive odours, which was overwhelmingly strong in the areas where people remained in bed. We observed staff frequently using ‘air freshener’ sprays throughout the day, especially after people had used the bathrooms, toilets or been assisted with personal care in their bedrooms. This indicated that there is a practice to cover offensive smells in the home, which does not promote people’s health or address the hygiene and cleaning practices within the home. The bedrooms were of a similar layout and clean. Some bedrooms are being refurbished and not occupied. All the bedrooms had furniture and furnishing that did not match; appeared old, some wardrobe doors were ajar or had to be pulled hard to open and loose divan headboards. The bedding was mis-matched and looked worn and tired. Some people who were more independent had personalised their bedrooms with ornaments, photographs and pictures. People who remained in bed were provided with special bed and fitted with cot sides for their safety. However, these bedrooms were not homely or personalised. The Expert saw ‘dried brown matter’ on the wall in one bedroom and was told by the Registered Manager the person ‘often spat out food’ (weetabix), which landed on the wall. This shows the standards of cleanliness and attention to detail is poor. The Expert used the passenger lift. They said the lift was ‘rickety and bumpy’ and had indentations in the walls of the lift, which we also found, having used the lift. The Responsible Individual told us the lift was part of the refurbishment plan.


We saw paper stuffed in a ventilation shaft under the stairs and a used ashtray in the foyer. When we pointed this out to the Responsible Individual they said ‘it did not cause a problem’. This highlighted that general standards within the home and also indicated that some people may be smoking in the home. We concluded from the site visit to the home that there were significant care, hygiene and management issues. Our findings also contradicted what the Registered Manager had stated in the self-assessment, as the home’s refurbishment was clearly ‘not completed’. We received mixed responses regarding laundry and people’s clothing. Several people told us they were happy with the laundry arrangements. One lady told us she prefers to wash her clothes by hand and would give the larger items for washing. Relatives did express concerns to us regarding missing items of clothing, which they had reported to the Registered Manager. We were unable to clarify the laundry arrangements from speaking with the staff on duty and the complaints records did not show concerns raised by relatives regarding missing clothing. This indicates the laundry arrangement should be made clear and complaints made regarding missing items of clothing should be addressed. (Also refer to the section ‘Complaints & Protection’) We spoke with the cleaner; who confirmed she cleans the bedrooms and the communal areas such as the bathrooms, toilets and lounges. There is only one cleaner and she had not been asked to do any extra cleaning, in light of the requirements and recommendations made by the Environmental Health Officer. They said they had received training and had a good supply of cleaning products and protective clothing. We observed staff wearing protective clothing when assisting people. Staff gave us examples of how they help people with their personal care tasks and hygiene practices. Although we saw staff did wear aprons and gloves when handling food, the Expert had to intervene and ask a carer to change her apron and gloves as she was about to help a lady with personal care tasks. Some staff told us they have recently started training in ‘infection control’ but had been working at the home for several months. This showed the lack of good hygiene practices and lack of prompt infection control training and monitoring within the home. The Responsible Individual told us that he is at the home on a daily basis and does not complete the formal monthly visits known as the ‘Regulation 26 visits’. This means they have a duty to visit to monitor the service in accordance with the standards. Therefore, inspite of the Responsible Individual being at the home, they have failed to identify and address the practices and environmental issues within the home, which significantly affects people’s health, safety and well-being. (See Health & Personal Care, Staffing and Management & Administration)


Staffing The intended outcomes for Standards 27 – 30 are: 27. Service users’ needs are met by the numbers and skill mix of staff. 28. Service users are in safe hands at all times. 29. Service users are supported and protected by the home’s recruitment

policy and practices. 30. 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 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels and staff training needs to improve so that people’s care needs and requirements are met safely and timely. EVIDENCE: We wanted to find out whether the numbers of staff and their care skills are able to meet the needs of the people living at Vishram Ghar. The information we gathered from the self-assessment tool completed by the Registered Manager stated that ‘there are sufficient staffing levels to ensure needs of residents are met in full’. People using the service benefit from having staff that speak a number of Asian languages that promotes two-way communication. This was evident as we saw the good rapport between some staff with the people using the service. We received mixed responses and comments from people using the service and their relatives, including the surveys, regarding the staff and their skills to look after the people living at the home. The comments received included: “In the last place everyone spoke English, here I can speak to the girls and they speak to me”


“Some staff will listen but others do not” “One or two are alright but not everyone” “All the girls are good” “All staff are good – better than at home on my own” “Most of the time a lot of staff are busy with patients but when staff are approached for help, the staff say that they are short staff and this is on a regular basis” “Staff are in need of extra training” “Carers at the home need more training. Staff need extra training to look after people with dementia. We also received comments and suggestions as to how the service could improve from the people living at the home, their relatives, the General Practitioner and the staff surveys. This indicated that staffing levels and skills did not sufficiently meet individual’s needs, contradicting the comments in the self-assessment tool completed by the Registered Manager. Comments received in the surveys included the following: “Teamwork is required” “More people trained like staff/nurse is required especially in the evening where there is staff shortages” “On-going staff training” “Have a gallery of staff showing names, positions and qualifications. Spot checks to be carried out by all management even during the night. All staff to have relevant qualifications according to their role. To ensure they have enough staff at all times” We received a copy of the staff rota and found there were three carers and a senior carer on duty along with the cleaner and kitchen staff. The Expert and we had observed the morning and lunch-time periods to be rushed, where staff were not able to respond to the needs of people to call bells and checks on people that stayed in bed. For example we heard people calling for help and having to wait for a period of time before staff assisted people with personal care tasks. We shared our observations with the Registered Manager and the Responsible Individual. This clearly highlighted that staffing levels are insufficient at busy times and this is likely to have an impact on the quality and safety of individuals.


We wanted to find out how staff were recruited and whether the recruitment of staff promoted the health and well-being of people who use the service. The staff spoken with and records viewed showed that staff recruitment procedures were satisfactory. We wanted to know what induction and training is completed by the staff. Whilst one new member of staff in post told us the induction training was provided by the Registered Manager and included some practical tasks, another told they were shown how to give out medication and did not require training as they had previously worked as a carer. This showed that not all newly recruited staff completes an induction programme or their competency assessed to ensure they have the right care skills to look after the people using the service. The comments received in the staff surveys included: “I learn other skills whilst performing my role, I had previous experience in the care profession” “I was given training in a course” “I have previous experience in this area so I am fairly familiar with care requirements” We discussed with the Registered Manager and the Responsible Individual the need to provide induction training in line with current guidance and best practice. We suggested that they consider looking at the training organisations such as Skills for Care and develop a programme of training to ensure staff skills are in line with current best practice and guidance. The information we gathered from the self-assessment tool completed by the Registered Manager indicated 40% of staff had attained NVQ level 2 and above in care. Staff spoken with told us they had attended some training, which included moving and handling, protection of vulnerable adults training, health and safety, moving and handling. Some staff told us they had recently started a training course on infection control, which should have been covered in the induction training. This further supports the observations made and comments received, that demonstrates there is no planned staff training programme and the assessment of staff skills is not robust. This is reflected in the standard of care, hygiene practices and the management of the home that affects the quality of life people experience.


Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 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.

32. Service users benefit from the ethos, leadership and management approach of the home.

33. The home is run in the best interests of service users. 34. Service users are safeguarded by the accounting and financial

procedures of the home. 35. Service users’ financial interests are safeguarded. 36. Staff are appropriately supervised. 37. Service users’ rights and best interests are safeguarded by the home’s

record keeping, policies and procedures. 38. 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 the home is not robust and in some areas fails to recognise, protect or promote people’s health, safety and well-being, leaving people and staff at risk. EVIDENCE: The Registered Manager has been in post for a number of years and has attained the National Vocational Qualification level 4 and the Registered Manager’s Award. The people living at the home and the staff spoken with said the Registered Manager was approachable.


We wanted to find out how the management of Vishram Ghar affects the people using the service. The self-assessment tool completed by the Registered Manager was not comprehensive and did not reflect how the management, staffing and practices within the home promotes the health, well-being and independence of people. Staff told us the senior carer tells them their specific duties and responsibilities. The staff rota seen, in the first instance showed staffing levels had been considered to sufficiently meet the needs of individuals. However, when the Activity Worker was called in to help at lunch-time, it was evident that the staffing levels, roles and responsibilities does not allow staff to work effectively to meet people’s care needs, especially at busy times or due to increasing needs of people. The Expert observed a member of staff wearing excessive jewellery and could be at risk of injury to themselves or others, if the jewellery is accidentally caught or pulled. Vishram Ghar does have a quality assurance process whereby people living at the home and their relatives attend ‘Residents & Relatives meetings and receive quality assurance questionnaires. The Responsible Individual told us that the results from the Quality Assurance are sent out to the relatives of the people using the service, but was not available to us to read. Relatives told us that they have attended a number of ‘Residents and Relatives meetings’, being involved in developing the menus and raising concerns with the Registered Manager and the Responsible Individual. We read the minutes of the last meeting dated 6th January 2009, which covered topics such as meals, medication and concerns. Whilst some visiting relatives told us they often had to remind the management team of concerns that need addressing, it showed there was another forum where concerns could be raised. (Also refer to the section ‘Complaints & Protection’) We wanted to find out how people are supported to manage their money. A visiting relative described the arrangement in place and they were satisfied with this. We looked at the records and the amount of money kept for two people. Whilst this showed a balance owing to the individual, there is no evidence that the balance is correct as relatives and staff are not required to sign for the transactions. Therefore, this system is potentially left open to abuse. We read the minutes of the senior staff meetings, which showed there was some communication with staff about the people using the service. We received mixed responses in the staff surveys and from talking with staff on the day about supervision and attending meetings. The majority stated they do not have supervision; there is no staff meeting for care assistants and only have handover meetings at the start of each shift with regards to the people living at the home. The lack of communication with staff was demonstrated in the event when the Environmental Health Officer closed the non-vegetarian


kitchen for poor state of hygiene. This shows management are not open and transparent with the staff. The records relating to the people using the service are not kept up to date and they are not in good order or accessible to staff providing the care. People using the service and their relatives should be made aware of their records and they should be involved in care planning to ensure their care and support preferences, are met by the home’s staff. The Responsible Individual is at the home on a daily basis and told us he does not conduct the formal monthly visits known as ‘Regulation 26 visit. In light of the many issues highlighted with regards to the service, including the actions taken by the Environmental Health Officer, the Responsible Individual must re-consider starting the monthly Regulation 26 visits. They should produce reports to assess the quality of the service and the standards within the home, which can be monitored. Whilst the information gathered from the self-assessment tool completed by the Registered Manager showed there is a programme of maintenance. It was evident that the refurbishment of the home was incomplete and no action plan to address areas highlighted by the Environmental Health Officer. The evidence gathered from the site visit and reviewing of records, showed the home must make significant improvements to ensure compliance with health and safety and to ensure the home is ‘fit for purpose’. The contents within this report demonstrate the management and leadership of the service needs to improve.


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 (Commendable) 3 Standard Met (No Shortfalls) 2 Standard Almost Met (Minor Shortfalls) 1 Standard Not Met (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 ENVIRONMENT

Standard No Score Standard No Score

1 2 19 1 2 X 20 1 3 1 21 1 4 X 22 X 5 X 23 X 6 N/A 24 2 25 1

HEALTH AND PERSONAL CARE 26 1 Standard No Score

7 1 STAFFING 8 1 Standard No Score 9 1 27 1

10 1 28 2 11 X 29 2

30 1 DAILY LIFE AND SOCIAL

ACTIVITIES

Standard No Score 12 1

MANAGEMENT AND ADMINISTRATION

13 3 Standard No Score 14 3 31 1 15 1 32 X

33 2 COMPLAINTS AND PROTECTION 34 X Standard No Score 35 1

16 1 36 1 17 X 37 1 18 1 38 1


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. Standard Regulation Requirement Timescale for action

1. OP3 14 The person responsible for assessing the needs of the people must be suitably qualified or trained to ensure details of the care needs are obtained fully and re-assessed when changes occur to ensure needs are known. Consideration should be taken into account about the individual cultural, diversity and lifestyle preferences to ensure the home is able to meet the needs. This is to ensure the individual care needs are identified and can be met safely. By failing to do so you are in breach of Regulation 14, which is an offence under the Care Homes Regulations 2001.

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2. OP7 15 Care plans must be comprehensive, reflecting all aspects of care, including information provided in the social workers assessment, the safety measures identified from risk assessments, giving staff clear guidance and provides

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information as to how the person wished their care to be carried out and their preferred daily routines. This would ensure care needs can be met safely, risks minimised and staff promote people’s health, safety and wellbeing. By failing to do so you are in breach of Regulation 15, which is an offence under the Care Homes Regulations 2001.

3. OP7 15(2) Care plans must be kept under review and updated, when changes have been identified and in consultation with the person and their relatives. This would ensure changing care needs are known and care be met safely. By failing to do so you are in breach of Regulation 15(2), which is an offence under the Care Homes Regulations 2001.

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4. OP8 13 Suitable provision of hand washing facilities must be provided to prevent the risk of infection or spreading infection by providing liquid soap in the soap dispensers and follow the best hygiene practices. This would ensure people are not at risk of cross infection and best hygiene practices are followed to protect people. By failing to do so you are in breach of Regulation 13(3) of the Care Homes Regulations 2001.

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5. OP8 12, 13 Staff must receive training to meet people’s assessed needs. This includes:

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• Pressure area care to be able to monitor, identify and take action to prevent pressure sores developing;

• Hygiene training and follow best practices to ensure people’s health is protected, and

• Training in infection control and use of protective clothing to prevent the risk of cross infection and promotes people’s health and safety.

This would ensure people are protected by trained staff that follow best practice to promote health and safety. By failing to do so, you are in breach of Regulation 12, 13, 13(3), which is an offence under the Care Homes Regulations 2001.

6. OP9 13(2) The registered person must carry out an assessment to ensure people who wish to self-administer over the counter medication and are provided with lockable space in which to store medication. To ensure people take their medication and is stored safely in their room. By failing to do so you are in breach of Regulation 13(2), which is an offence under the Care Homes Regulations 2001.

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7. OP9 13(6) & 18(1)(c)

(i)

Staff must receive regular training in or by other measures to safely administer medication and records available to verify that trained staff meets their needs. To ensure resident’s health,

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safety and wellbeing. By failing to do so you are in breach of Regulation 13(6) & 18(1)(c) (i), which is an offence under the Care Homes Regulations 2001.

8. OP10 23(2)(j) There must be sufficient numbers of toilets, wash hand basins, baths and showers fitted with supply of hot and cold water for people to maintain their health and independence. This would ensure people are not limited to using toilets and baths in close proximity to their living area and having to use cold water for bathing to protect their health and well-being. By failing to do so you are in breach of Regulation 23(2)(j), which is an offence under the Care Homes Regulations 2001.

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9. OP12 16(2)(n) To make sure people are consulted about their social interests and activities to be arranged by the home and put into place a range of these for people. This would ensure people have opportunities to participate in activities of interest to them that promoted their well-being. By failing to do so you are in breach of Regulation 16(2)(n), which is an offence under the Care Homes Regulations 2001. (This requirement with an original timescale for action of 25/04/08, 24/09/07 and 31/12/07 remains unmet).

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10. OP15 16(2)(i) To ensure dietary needs are met by: • People being consulted about

their dietary needs and reflected in their care planning requirements;

• Have menus that offer a choice of vegetarian and non-vegetarian meals; and,

• Where staff assists people in eating meals do so in a manner that is discreet, sensitive and respectful to the individual who may take time.

This would ensure people’s dietary needs and preferences are met that promotes their health and well-being. By failing to do so you are in breach of Regulation 16(2)(i), which is an offence under the Care Homes Regulations 2001.

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11. OP16 22(4) The registered person must follow the home’s complaints procedures and timescale to fully investigate and conclude the complaint, informing the complainant of the actions to be taken. This would ensure complaints are quickly addressed to protect the health, safety and well-being of people. By failing to do so you are in breach of Regulation 22(4), which is an offence under the Care Homes Regulations 2001.

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12. OP16 17(2) A record must be maintained of all the complaints, both written and verbal, made by people living at the home or their representatives, detailing the nature and the actions taken by the registered person in respect

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of any such complaints. This would ensure complaints made could be audited and measured against the home’s complaints procedure to ensure people’s safety, well-being and rights are respected. By failing to do so you are in breach of Regulation 17(2), schedule 4(11), which is an offence under the Care Homes Regulations 2001.

13. OP18 13(6) All staff employed by the home to receive training which equips them with the knowledge as to the types of abuse, including signs people who are being abused may display, and for staff to understand their roles and responsibility in protecting and supporting individuals in their care. This would ensure people are protected from harm, risk and abuse by trained staff. By failing to do so you are in breach of Regulation 13(6), which is an offence under the Care Homes Regulations 2001.

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14. OP19OP26 OP20

23, & 16(2)(j)

The registered person must provide a safe home environment that is kept in good state of repair and maintenance, tidy, accessible and fit for purpose. These include the kitchens, the dining rooms, lift and fire exits and where necessary seek advice from Environmental Health or the Fire Service. Removal of old or unused equipment such as wheelchairs currently stored in the bathroom/toilets.

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This would ensure people’s health and well-being is promoted. By failing to do so you are in breach of Regulation 23, which is an offence under the Care Homes Regulations 2001.

15. OP20 OP25

13(4)(c) & 23(2)(p)

The registered person must provide adequate: • Heating in the dining room so

that people are warm when they use the dining room especially at meal times, and

• Lighting in the corridors used by people at all times.

This would ensure people’s health, well-being and safety that promotes and maintains their independence. By failing to do so you are in breach of Regulations 13(4)(c), 23(2)(p), which is an offence under the Care Homes Regulations 2001.

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16. OP21

23(2)(j) The registered person must provide sufficient numbers of bathrooms and toilets facilities in good working order and in close proximity to people’s private bedrooms and communal areas. To ensure people’s health, well-being and independence is promoted. By failing to do so you are in breach of Regulation 23(2)(j), which is an offence under the Care Homes Regulations 2001.

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17. OP26 23(2)(d) and

16(2)(k)

The registered person must take steps to make sure all parts of the home are kept clean and eradicate offensive smells. To ensure all parts of the home

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are safe, clean and suitable to this people living at the home. By failing to do so you are in breach of Regulations 23(2)(d) and 16(2)(k), which is an offence under the Care Homes Regulations 2001.

18. OP26

13(3)(4) The registered person must provide: • Suitable hand washing

facilities to prevent the risk of cross infection and the spread of infection by eliminating the use of bars of soap;

• Staff correctly wearing protective clothing; and

• Follow the best hygiene practices.

This would ensure people are not at risk of cross or spread of infection that promotes their health, safety and well-being. By failing to do so you are in breach of Regulation 13(3), which is an offence under the Care Homes Regulations 2001.

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19. OP27 18(1)(2) The registered person must have sufficient staffing levels that meet the assessed needs of people living at the home and reviewed regularly to ensure staff levels continue to meet people’s needs. This would ensure people’s health, safety and wellbeing is promoted and maintained. By failing to do so you are in breach of Regulation 18(1)(2), which is an offence under the Care Homes Regulations 2001.

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20. OP30 18 Staff must be trained to provide care to meet people’s assessed care needs and daily living. This

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includes: infection control and protective clothing; pressure care management; health and safety, the safe use of equipment such as the Parker bath; access staff competency by supervision to ensure the health and safety is adhered to. This would ensure people’s health and safety is maintained. By failing to do so you are in breach of Regulation 18, 13(5) and 12, which is an offence under the Care Homes Regulations 2001.

21. OP31 26 The registered person must conduct the monthly visits and produce a report detailing the findings and action plan to address issues and shortfalls with timescales to ensure the health, safety and well-being of people. This would ensure the home is managed and the needs or people are met safely. By failing to do so you are in breach of Regulation 26, which is an offence under the Care Homes Regulations 2001.

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22. OP35 16(2)(l) The registered person must ensure the system for recording money held in safe-keeping is robust and auditable to avoid abuse or theft. This would ensure money held on behalf of individual is safe and secure. By failing to do so, you are in breach of Regulation 16(2)(l), which is an offence under the Care Homes Regulation 2001.

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23. OP36 13(5)(6) &

18(1)(2)

The registered person must ensure that staff receive regular supervision that ensures people receive care from staff that are competent that ensures people’s health and wellbeing. This would demonstrate and ensure the staff team are trained in accordance with current best practice to ensure the health, wellbeing and safety of people protects people. By failing to do so you are in breach of Regulation 13(5)(6) and 18(1)(2), which is an offence under the Care Homes Regulations 2001

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24. OP37 17 The registered person must ensure the records relating to the people using the service must be kept up to date and in good order, including the care plan and the care files. The individual and where appropriate their advocate and main carers should be consulted and made aware. This would ensure people’s health and care needs are known and what support they receive. By failing to do so you are in breach of Regulation 17, which is an offence under the Care Homes Regulations 2001.

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25. OP38 12, 13, 16 and 23

The registered person must ensure the health and safety practices within the home, protects and promotes the health, safety and wellbeing of people. These include ensure staff follow best practice and guidance in relation to health and safety; infection control and are provided with suitable

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equipment to serve hot meals in which prevents spillage, scalding or accidents. This would ensure people are protected and their well-being is promoted. By failing to do so you are in breach of Regulation 12, 13, 16 and 23, which is an offence under the Care Homes Regulation 2001.

RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out.

No. Refer to Standard

Good Practice Recommendations

1. OP1 The information about the home: Statement of Purpose and the Service User Guide should contain the correct contact details for the Commission for Social Care Inspection.

2. OP9 Advice should be sought from the Pharmacist to ensure the storage of controlled drugs comply with the Misuse of Drugs (Safe Custody) (Amendment) Regulation 2007 to help prevent misuse or theft.

2. OP10 The registered person should ensure people to wear their own clothing and arrangements are in place for people to have their clothing returned to them after being washed.

3. OP12 A programme of activities should be planned and displayed in the home for people to know what social, leisure and religious events are taken place.

4. OP15 The menus displayed are available in alternative formats suitable for the needs of the people using the service.

5. OP19 OP20 OP12

To consider the seating arrangement in the lounges that would encourage people to engage in stimulating conversation and activities.

6. OP24 To consider improving the décor, furniture and furnishing for a co-ordinated bedroom with new bed linen. To ensure individuals preferences is taken into account and best


practice guidance from organisations who advises as to how the décor and furnishing can impact and improve the quality of life for people

7. OP28 The home should increase the numbers of staff that have attained or are in the process of attaining National Vocational Qualification level 2 in care to meet the needs of the people using the service.

8. OP29 It is recommended that the home’s induction programme is reviewed and updated, considering the Skills for Care training, which promotes the current best practice to ensure staff have the right basic skills and training to support the people living at the home.

9. OP30 It is recommended that there is a robust planned training programme for all the staff to maintain their skills and practice in line with current best practice and guidance.

10. OP33 The home should consider measuring the outcome of the quality assurance exercise against the statement of purpose to show if the expectations of the service are met, help identify areas of improvement and ensure the statement of purpose evolves as the service develops.


Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: [email protected] 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

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