Inspection on 15/04/08 for Broadleas Residential Care Home

This is the latest available inspection report for this service, carried out on 15th April 2008.

CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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Extracts from inspection reports are licensed from CQC, this page was updated on 23/11/2008.

CARE HOMES FOR OLDER PEOPLE Broadleas Residential Care Home 9 Eldorado Road Cheltenham Glos GL50 2PU Lead Inspector Mrs Kate Silvey Unannounced Inspection 15th April 2008 10:15 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 DS0000070648.V362506.R02.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. DS0000070648.V362506.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Broadleas Residential Care Home Address 9 Eldorado Road Cheltenham Glos GL50 2PU 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) 01242 256095 01242 256095 Camelot Healthcare Ltd Mrs Katherine Ruth Halstead Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20) of places DS0000070648.V362506.R02.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 providing personal care - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Old age, not falling within any other category (Code OP) The maximum number of service users who can be accommodated is 20. New Service Date of last inspection Brief Description of the Service: Since October 2007 Camelot Healthcare Limited are the new providers. The home is a detached house situated in a quiet residential area of Cheltenham. There are twenty single bedrooms with en-suite toilets and washbasins. The bedroom accommodation is located on the ground floor, first floor, a mezzanine level and the second floor. There are two bathrooms both equipped with a bath hoist, and a large shower on the second floor. A shaft lift provides access to all but the top floor and mezzanine level. The communal rooms on the ground floor consist of a lounge and separate dining room. The dining room has large patio doors with access to the garden. The gardens, mainly at the rear of the home, are well tended. There is a small lawn at the front, and car parking areas to the front and side. The home is near the railway station, and about a mile from the centre of Cheltenham. Adjacent to the railway station are some shops including a newsagent/general store. The accommodation fees range from approximately £500.00 to £650.00 and additional charges include hairdressing, chiropody, escort duties and newspapers. Information regarding how fees are calculated and the criteria for when local authority funded places are available is in the homes Service User Guide. DS0000070648.V362506.R02.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 2 star. This means the people who use this service experience good quality outcomes The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. One inspector undertook this unannounced key inspection in one day. Nineteen service users were accommodated and most were seen and spoken to. Many service users were able to have a conversation with the inspector and three service users surveys were returned. A visitor was spoken to directly to obtain their view of the care home and two relatives/visitors survey were returned to the Commission. There was direct contact with the home’s manager, assistant manager and four members of staff. A number of records were looked at including care plans, risk assessments, health and medication records. The care records of three people accommodated were looked at in detail. The environment was fully inspected and staff were observed engaging with people living in the home. The registered manager returned the Commissions’ Annual Quality Assurance Assessment, this is a self-assessment about the home and is a legal requirement. What the service does well: People are normally only admitted to the home after a detailed assessment is made to help ensure their needs can be met, and the information is used to plan their care. One new person said they were invited to view the home before they moved in and were made most welcome by the staff. People were seen being treated with dignity and respect. Another new person commented that the staff were ‘a terrific lot who look after me well’. The care plans seen had detailed information to help staff know what to do, all areas were included for example; good nutritional assessments and regular weight checks. There was evidence that people are well supported by healthcare professionals, for example the continence adviser and district nurse. One survey from a person living in the home stated, ‘night or day I am looked after well’ and ‘staff DS0000070648.V362506.R02.S.doc Version 5.2 Page 6 are very quick to see to any illness’, another person stated,’ I always get the support I need on a day to day basis’ A survey from a relative said ‘my mother now calls Broadleas her home and does not want to go anywhere else’ and ‘they are very considerate to her needs and tell us of any change straight away. The manager takes complaints seriously and investigates them well, and people are safeguarded from abuse as the staff have appropriate training. The home is well maintained, and attractively and appropriately furnished with suitable adaptations to help older people. The gardens at the rear are well kept and people said they liked to use the garden when they could. Services and equipment are inspected and serviced as required to provide a safe environment. The home has a comprehensive staff induction in line with the six areas identified by Skills for Care, which helps to ensure new staff have basic skills. What has improved since the last inspection? What they could do better: All people have a detailed care plan to help staff know what to do, more meaningful daily records and monthly reviews would help staff know the plans are working well. Medication could be managed more safely as some administration records were incomplete. It is recommended that a monthly audit is completed to identify any poor practice. Some people would welcome additional activities and the staff having more time to sit and chat or take them out for walks locally. Generally the home was clean and free from malodour, however, some rooms required regular carpet cleaning. There were some minor maintenance issues that required attention and one fire safety issue. The hall carpet looked well worn but was not hazardous. The manager stated that there were plans to improve the hall. There should always be sufficient staff on duty to ensure that people’s needs are met in an unhurried manner and staff have time to talk to people. DS0000070648.V362506.R02.S.doc Version 5.2 Page 7 Formal staff supervision should be completed to help ensure that any new information in the homes policies is upheld and that staff are appropriately meeting everyone’s needs. The manager is responsible for ensuring health and safety matters are addressed and may benefit from additional training to ensure that all areas are covered and hazards identified. 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. DS0000070648.V362506.R02.S.doc Version 5.2 Page 8 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 DS0000070648.V362506.R02.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 3 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People are normally admitted to the home only after a detailed assessment is completed to help ensure their needs can be met and the information is used to plan their care. EVIDENCE: We looked at a pre-admission assessment for one person and it had some good detailed information to help the manager identify care needs. We spoke to the new person who was satisfied that the home had provided everything he required from the beginning, as he needed a lot of help. He commented that the staff were ‘a terrific lot who look after me well’. Another new person said they were invited to view the home before they moved in and were made most welcome by the staff. DS0000070648.V362506.R02.S.doc Version 5.2 Page 10 In our survey one person commented that they did not receive any information before moving in as it was an emergency admission, but they were perfectly happy in the home and glad that it was the right decision. The new providers were updating the Statement of Purpose and Service User Guide, they will be looked at during the next key inspection or Annual Service Review. The information regarding the fees payable for accommodation and how they are calculated should be included in the Service User Guide for prospective people to see, in line with the Fees and Frequency Regulations. Intermediate care is not provided in the home. DS0000070648.V362506.R02.S.doc Version 5.2 Page 11 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 & 11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. All people have a detailed care plan to help staff know what to do, more meaningful daily records and monthly reviews would help staff know the plans are working well. People were seen being treated with dignity and respect. Medication could be managed more safely as some administration records were incomplete EVIDENCE: Two care plans were looked at in detail and both the people were seen and one was spoken to. Another plan was seen and we spoke to four other people in their own bedrooms. We spoke to the majority of people in the lounge individually, but some were given the opportunity to have a private conversation in their own room if they preferred. The care plans seen had detailed information to help staff know what to do, all areas were included for example; good nutritional assessments and regular weight checks DS0000070648.V362506.R02.S.doc Version 5.2 Page 12 The healthcare records of visiting professionals were informative which helps to plan any further visits and provides continuity. There was evidence that people are well supported by healthcare professionals for example the continence adviser and district nurse. Manual handling assessments are only completed when required. Risk assessments had been completed and any risks identified were included in the care planning. Care plans were reviewed monthly but there was not enough information to make it meaningful and support that the plan was continuing to work well. The daily records could have been more detailed which would help with the monthly review information. It was recommended that some of the records completed by the staff in the ‘conversation book’ should be entered in individual records for people in the home, to comply with Data Protection and ensure all information can be easily retrieved. One care plan required updating as the person had deteriorated and the information was incorrect. We looked at the records in the bedroom for a person cared for in bed, which included a change of position chart and a record of food and drink taken. The doctor and family were aware of the deterioration and all care was being given to help ensure the person was comfortable. The manager stated that the care staff had completed palliative care training and the prevention of pressure ulcers. One survey from a person living in the home stated, ‘night or day I am looked after well’ and ‘staff are very quick to see to any illness’, another person stated,’ I always get the support I need on a day to day basis’ A survey from a relative said ‘my mother now calls Broadleas her home and does not want to go anywhere else’ and ‘they are very considerate to her needs and tell us of any change straight away. We looked at the medication storage and administration records. The medication policy and procedure was in the process of being updated. The manager orders the medication for the home, but is training the assistant manager to eventually take over this task. Storage was secure, clean and well organised. Some medication had not been signed into the home, which was unusual, and one bottle of liquid medication had not been dated when opened. We did a spot check of the monitored dosage system and the controlled drugs and all were correct. The transcribed medication records had not been signed correctly and were poorly written, the exact wording must be copied from the medication container and be legible. Medication prescribed ‘as required’ should have a protocol to help ensure that staff consistently administer the medication appropriately. The manager stated that she had already discussed completing this with the local pharmacist. There were no homely remedies stored and no one was self-medicating. The home had an up to date medication reference and information sheets from the pharmacy for the medication administered in the home. DS0000070648.V362506.R02.S.doc Version 5.2 Page 13 The manager stated that all staff had completed medication training with the exception of two new care staff. The manager does not allow care staff to administer medication until they are trained and competent, the manager assesses their competency and all staff have medication training updates every three years. It is recommended that a monthly audit is completed to identify any poor practice. We were informed by the care staff that medication administration by the day staff each morning takes approximately 90 minutes and sometimes longer. DS0000070648.V362506.R02.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Some activities and entertainers are provided but more time spent on organising additional interests people want would improve their quality of life. Families and friends are made welcome in the home and kept informed of how their relatives are when required. People are consulted about how the home is run and can influence change. The home provides a varied diet, and the catering staff are trained to know what is suitable and consider everyone’s preferences. EVIDENCE: We observed the handover period between shifts and spoke to all the staff afterwards. Staff said that there is not much time to do activities in the afternoons as one carer prepares the supper, which on the day of the inspection took most of the afternoon to organise. Care staff also complete laundry duties in the afternoon, which takes time delivering clean laundry to everyone. However, people appreciated the care taken with supper and were seen enjoying the pancakes served. One person said that there was some entertainment but they would like more activities. DS0000070648.V362506.R02.S.doc Version 5.2 Page 15 One new person was an accomplished painter and showed us a collection of painting previously completed, but felt unable to do any more as there was little space to complete it. It may be possible to develop people’s artistic talents by using the dining room for classes. We spoke to several people and one person said that ‘more activities would be nice’, another person said ‘ the entertainers are boring’, and ‘there is no conversation with staff they are too rushed, which means I am left alone for too long’. One person thought staff did not have enough time to take them out locally. Two people spoken to were content to entertain themselves with reading and watching television in their rooms. The manager stated that there is normally a monthly activity programme, but there have been no new activities started since the last inspection. The staff are helping to raise funds for activities with raffles, but trips out have not been planned as there are insufficient funds available. The AQAA stated that more external entertainers have been organised in the last 12 months, which includes music and movement classes. However, the manager plans to provide a more varied activities programme. One survey said ‘there are activities to take part in, but I am lucky because I can usually manage to create my own activities’. Another person said ‘we have the music man once a week, we have chair aerobics once a fortnight and we can play ball games anytime’ The Company are organising a summer ball where the people in all four homes can join in and meet one another. A relatives survey commented that ‘maybe a little more activity would improve the care’ The home welcomes visitors to the home and one relatives survey stated, ‘Broadlea’s staff also treats me and mums family and friends well, i.e. a cup of tea and cake is always offered to us. The manager keeps families informed when required to help ensure they know how their relatives are. Religious services are held in the home and when possible people can visit the local churches. The AQAA stated that people are encouraged to have a more active involvement in the home by way of completing questionnaires and twice weekly chats. Recently this has meant that the menus have been altered to include people’s requests. We spoke to the cook and discussed peoples preferences and special diets. The cook was knowledgeable and knew what people liked and disliked as the information was in the kitchen. Special diets are catered for which included diabetic, gluten free and soft diets. As far as possible people with diabetes have similar desserts with sugar free alternatives, soft diets looked attractive as all foods are separately blended. More information on gluten free diets is recommended to avoid repetition and provide a palatable alternative. The person eating the gluten free meals was not entirely satisfied as it was a new experience and more variety was required. The cook agreed the home needed a Gluten Free recipe book as an aid to providing more variety. DS0000070648.V362506.R02.S.doc Version 5.2 Page 16 The four week menus looked varied and an ‘alternative’ menu had recently been suggested to provide people with more choice. The chef said the new alternative menus would be laminated and given to each person to keep in their room so that they knew what else could be provided in place of the main menu. We looked at the chefs diary where it was recorded what people had chosen each day. The chef stated that staff ask people at breakfast what they would like for lunch. We spoke to people who said; ‘ The cook does well’, ‘the food is alright’, ‘there is a choice of food’. The surveys stated ‘ The food is varied and cooked well’, ’If we make a request on the menu it is always carried out’, ‘ I enjoy the meals here because they are so varied’ All staff that handle food have completed a Food Hygiene course and the chef has also recently attended a two day course on ‘Nutrition for Older People’, and will be implementing the lessons learnt there. The chef stated that the Environmental Health Officer came in December 2007 and that recommendations had been completed. The kitchen was clean, organised and there was fresh produce available. DS0000070648.V362506.R02.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager takes complaints seriously and investigates them well. People are safeguarded from abuse as the staff have appropriate training and there are procedures for them to follow should they become concerned. EVIDENCE: The complaints procedure was in the hall and also in the Service User Guide, which people have a copy of. The manager had thoroughly investigated an anonymous complaint for us last year and the problems had been resolved. There have been no other complaints since the last inspection. All staff have had the Protection of Vulnerable Adults training part 1 and were soon to have additional training to upgrade their knowledge. The care staff spoken to said they did not have any training needs and knew about how to protect vulnerable people and inform the manager or provider about any suspicions of abuse. The home has comprehensive policies and procedures for safeguarding people and ‘whistle blowing’, which is included during staff inductions to ensure everyone knows what to recognise and how to respond. DS0000070648.V362506.R02.S.doc Version 5.2 Page 18 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, 20, 21, 22, 24, 25 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well maintained and communal rooms have been refurbished recently. People said the home was kept clean, but some carpets required attention. Adaptations are provided to help maintain peoples independence. EVIDENCE: The lounge had been refurbished and looked attractive with a new colour scheme chosen by the people living in the home. There were new chandeliers, which helps to improve facilities for reading. The dining room had new furniture and a doorway had been altered to improve access from the kitchen. The first floor bathroom was being refurbished to provide improved assisted bathing facilities. The home has attractive, secure gardens, which people can access through the dining room patio doors, the area is well used on warm days. DS0000070648.V362506.R02.S.doc Version 5.2 Page 19 Suitable adaptations are provided to ensure people can use their ensuite toilet facilities and safely access areas where steps are involved. There are adequate bathing facilities on each floor. One person had an adjustable bed to help the staff meet all her care needs. One person spoken to requested a more comfortable armchair, which the manager agreed to find. The bedrooms were personalised with many ornaments and pictures. We looked around the home and identified a few areas for improvement; The carpets in room 11 and 15 required cleaning, in room 17 there was no lampshade in the ensuite toilet, in room 14 the carpet required cleaning, the radiator cover was loose and the window was unrestricted, in room 11 the fire door was propped open, and a wall in room 6 required some attention. Room 5 had a free standing radiator, which requires a risk assessment and appropriate action. The hall carpet looked well worn but was not hazardous. The manager stated that there were plans to improve the hall. The laundry had appropriate equipment and was clean and organised, but required decorating as some wallpaper was peeling. The manager stated that this would be repaired when the planned extension commences, and the laundry will be re-sited. There was a good infection control policy in the laundry to inform staff of the procedures to be followed. The AQAA stated that eight staff had received training in infection control. We saw the cleaning equipment cupboard where Control of Substances Hazardous to Health (COSHH) regulations were met to include all the information required and it was looked. There was a cordless phone positioned on the landing for people to use upstairs, information about this facility should be included in the Service User Guide. The manager stated that a new telephone area was planned on the ground floor, where people could use the payphone in privacy. One person said the home was ‘clean enough’ and two surveys stated the home was always clean and one said it was usually clean. Five people spoken to individually said their rooms were cleaned regularly, and people in the lounge said the home was kept clean. The home had recently employed a new cleaner. We spoke to a person that had experienced a problem with the ensuite toilet drain, and was now satisfied that the new providers had permanently solved the problem. One person was very pleased with the decoration of her bedroom, and had been able to choose the colours of the new carpet and curtains. It is recommended that the beds and bedding provided are audited for replacement as a few looked quite old and worn. DS0000070648.V362506.R02.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are generally satisfied that the care they receive meets their needs, but there are times when the staff may not have sufficient time to give them adequate attention. Evidence indicates that more staff are needed during the morning when needs are higher with bathing people and administering medication. The service recognises the importance of training, and tries to delivers a programme that meets the National Minimum Standards. The recruitment practice followed recognises the importance of effective recruitment procedures in the delivery of good quality services and for the protection of individuals. EVIDENCE: The manager stated that the home was now fully staffed. We looked at a copy of the staff rota, which indicated that there are two care staff on duty during the day and one at night, with another carer sleeping on the premises. We interviewed the new assistant manager who had completed NVQ levels 2 and 3 and an accredited medication course as well as other courses. The assistant manager has ten supernumerary hours each week to help with record keeping and is planning to complete NVQ level 4 in care. DS0000070648.V362506.R02.S.doc Version 5.2 Page 21 There are two cooks who cover the daily shifts from 8:00 to 14:00 hours and a domestic cleaner who completes 12 hours per week. Care staff also complete catering and laundry duties during the day. The AQAA stated that four of the ten care staff have a NVQ level 2 or 3 in care qualification and one is working towards NVQ level 2. This is the minimum standard and it is expected that the manager will ensure that the home has additional staff with a NVQ qualification. The operations manager agreed to send us a training schedule indicating all the training that had been completed by the staff. The registered manager was completing staff payroll information during the morning of the inspection, however, previously it had been agreed that the manager should be part of the care team in the morning for at least two hours. The new providers ‘Camelot Healthcare Limited’ have four care homes in Cheltenham, and there is usually a staff member referred to as a ‘floater’, who covers all the homes for staff sickness and holidays. However, this is not a member of staff who can come when the home is very busy. The manager was unsure when the ‘floater’ was last at Broadleas, but the operations manager stated that the company might have two ‘floaters’ soon to help with absences. Nineteen people were accommodated and several were highly dependant and required a lot of care and support. Three staff were spoken to individually, and four care staff on duty were spoken to at the staff handover meeting between shifts. Two staff said that the home needs more staff in the morning and that the medication administration takes between 1hour 30 minutes to 2 hours each morning to complete. The staff said their training needs were met, and only one new carer needed to complete a first aid course. The care staff had recently completed palliative care training and good training in skin care and the recognition/prevention of pressure ulcers. Two surveys said there is ‘usually’ staff available when you need them and one said there is ‘always’ staff available ‘day and night’. One person said ‘the staff are too rushed there is no conversation with them’ and one person said ‘I never have to wait for staff’. We looked at four recruitment records and all new employees Criminal Record Bureaux checks were looked at in the company’s head office on another day. The applications can identify any gaps in employment, it is recommended that the written interview notes record the exploration of any gaps. References are sought and generally two obtained, however, one of the care staff had one reference from a friend, which was insufficient. The manager said any weaknesses highlighted from referees are discussed with the staff member and reviewed to help ensure staff improve and progress. There was good evidence of previous training with copies of certificates obtained. The home has a comprehensive staff induction in line with the six areas identified by Skills for Care and a good example was seen completed, which included fire safety training on the first day. DS0000070648.V362506.R02.S.doc Version 5.2 Page 22 DS0000070648.V362506.R02.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has an experienced manager who has appropriate qualifications and tries to ensure that people have control over their way of life and surroundings by listening to what they want. Staff are not formally supervised to help ensure all areas of practice meets the homes philosophy of care and that any new policy updates will be upheld. People financial interests are safeguarded by staff completing clear records and following procedures EVIDENCE: The registered manager is qualified and experienced to run the home. One person commented that she was ‘very good’, and a relative said ‘ the manager and her staff always keep my mothers family informed about everything’. DS0000070648.V362506.R02.S.doc Version 5.2 Page 24 The manager said she feels well supported by the operations manager and the new providers The staffing levels indicate that the manager must look at the deployment of care staff more carefully to help ensure people’s needs are met appropriately. Care staff spoken said evenings were less busy and there was usually sufficient staff to met peoples needs. The results of the recent quality assurance survey given to everyone had not been collated, but the operations manager agreed to provide us with the information when it is available. We saw a random sample of the storage and recording of people’s personal monies. The money and recordings were correct with receipts for purchases kept and two signatures for every transaction, which helps to safeguard people from financial abuse. The manager had not regularly supervised staff and she agreed there was insufficient time to complete this task formally. The AQAA information provided by the manager, which could have been more detailed, stated that all required procedures were in place, but were undergoing a review with the new providers. The information also indicated that all equipment, gas appliances and electrical installations had been serviced or tested as recommended by the manufacturers instructions. The annual portable appliance testing was overdue. The manager is responsible for health and safety matters in the home and should have appropriate training to ensure that this is completed well and people are safe. The staff watch a fire training video and are regularly given a written and practical test to help ensure they understand the importance of the training and what to do in the event of a fire. Some equality and diversity issues are addressed and people are encouraged to become more actively involved within the residents meetings. Large print signs around the home help people with sight impairment to be more independent. More work is required to train staff and address all equality and diversity issues to help ensure that people can be confident that all their needs can be met, which includes disability, sexuality, race, religion, age and gender. DS0000070648.V362506.R02.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 4 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 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 3 18 3 3 3 3 3 x 3 x 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 4 2 X 3 DS0000070648.V362506.R02.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? New Service STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13 (2) Requirement The registered person must ensure that medication administration is completed safely; • all administration records must be signed • • medication must be dated when opened all transcribed records must be legible and signed ‘as required’ medication must have a protocol. 23/06/08 Timescale for action 31/05/08 • 2 OP27 18 (1) The registered person must ensure that there are sufficient staff on duty at peak periods of activity to help meet people’s needs. DS0000070648.V362506.R02.S.doc Version 5.2 Page 27 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP1 Good Practice Recommendations The information regarding the fees payable for accommodation and how they are calculated should be included in the Service User Guide. It is recommended that the daily records are more detailed which would help with the monthly review information. It was recommended that some of the records completed by the staff in the ‘conversation book’ should be entered in individual records It is recommended that a monthly medication audit is completed to identify any poor practice. It is recommended that there are sufficient staff to prepare supper. It is recommend that a risk assessment is completed and regularly reviewed for a portable heater used in bedroom 5. It is recommended that the bedroom wall in room 6 is attended to. It is recommended that the carpets identified in this report must be regularly cleaned or replaced. It is recommended that the beds and bedding provided are audited for replacement as a few looked quite old and worn. It is recommended that the written interview notes record the exploration of any gaps in employment. It is recommended that suitable and sufficient references are obtained when recruiting staff. It is recommended that the homes portable appliance DS0000070648.V362506.R02.S.doc Version 5.2 Page 28 2 OP7 3 OP7 4 5 6 OP9 OP15 OP19 7 8 9 OP19 OP26 OP19 10 11 12 OP29 OP29 OP38 testing is completed. 13 OP36 The registered manager should formally supervise staff to help ensure all areas of practice meet the homes philosophy of care and policies are upheld. It is recommended that an alternative, agreed by the fire officer, be used to prop open the door to bedroom 11 on the ground floor. The radiator and window restrictor in bedroom 14 needs attention. 14 OP38 15 OP19 DS0000070648.V362506.R02.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI DS0000070648.V362506.R02.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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