Inspection on 19/08/08 for Paisley Court

This is the latest available inspection report for this service, carried out on 19th August 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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.

Other inspections for this house

Paisley Court 11/05/06

Paisley Court 01/02/06

Paisley Court 07/09/05

Paisley Court 25/02/05

Paisley Court 13/07/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Paisley Court 36 Gemini Drive East Prescott Road Liverpool Merseyside L14 9LT Lead Inspector Julie Garrity Key Unannounced Inspection 19th August 2008 10:00 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 Paisley Court DS0000025191.V365198.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Paisley Court DS0000025191.V365198.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Paisley Court Address 36 Gemini Drive East Prescott Road Liverpool Merseyside L14 9LT 0151 2300857 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) manager.paisleycourt@careuk.com Community Health Services Limited Mrs Jayne Allison Kennie Care Home 60 Category(ies) of Dementia - over 65 years of age (60) registration, with number of places Paisley Court DS0000025191.V365198.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. That the service is varied to accept the admission of one named service user under the age of 65 years. Two places aged 55 for respite care accommodated on the respite unit 7th June 2007 Date of last inspection Brief Description of the Service: Paisley Court is situated in a residential area in the outskirts of Liverpool and is easily accessible by public transport and close to local shops. At the front of the building there is a large car parking area and at the rear of the property there is an enclosed garden, which individuals who live in the home can easily access. The gardens are divided into different seating areas. Paisley Court is a care home providing nursing care for 60 older residents who have mental health or behavioural support needs. Accommodation is divided into four units, two units on each floor. One of the units is for individuals who only stay for a short time (respite). One of the units is for gentleman only and the other two units have people living there who stay for a long time and are of either sex. Each unit has its own dining rooms and lounge areas. All bedrooms are single and have en-suite toilet facilities. All the places at Paisley Court are contracted to Liverpool Health Authority as part of continuing care, resulting in all referrals made to the home being through the team of consultants at the hospitals. Care Uk, which has several other care services through out the country, owns the home they have experience in providing care services to vulnerable people. The manager has worked in the home for several years and is supported by a deputy and senior staff team. Paisley Court DS0000025191.V365198.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The overall quality rating for this service is 2 stars. This means that the people who use the service experience good quality outcomes. The site visit was carried out over a period of one day. We arrived at the home at 10:00 and left at 18.20. We spoke with a total of ten people who live in the home and twelve staff and six relatives. The inspector was accompanied on the inspection by an “expert by experience”. Experts by experience are individuals who have personal experience of either living in or supporting a relative in a care environment. In some cases the expert by experience is an individual who has personal experience of either physical or mental ill health. The expert by experience was asked to talk to people and gather their opinions on what it feels like to live in Paisley Court. There was a limited amount of time available for the expert by experience and as such they concentrated on the dignity and opportunity to make choices of the individuals living in the home. We completed this inspection by a site visit to Paisley Court, a review of records available, these included care plans, medications, staff training, staff recruitment, policies and procedures, daily records, risk assessments and maintenance records. Records held in CSCI offices were also looked at. The main emphasis was discussions with people who live in the home, their relatives, staff and management. The inspector followed an inspection plan written before the start of the inspection to ensure that all areas identified in need of review were covered. All of the Key standards were covered in this inspection, these are detailed in the report. We also sent surveys out to the people living in the home and specifically asked where necessary that their relatives help them completed these. Six surveys were returned to us. Additionally staff surveys were sent out we received five of these. The arrangements for equality and diversity were reviewed throughout the visit and are detailed in this report. Particular emphasis was placed on the methods that the home used to determine individual needs and the practices that they put into place into meeting those needs. Feedback was given to the manager and the deputy during and at the end of the inspection. What the service does well: Paisley Court supports individuals with complex needs. There is good information available within the home that assists individuals, their relatives Paisley Court DS0000025191.V365198.R01.S.doc Version 5.2 Page 6 and stakeholders to understand the support that will be provided. Comments returned to us included “I visited the home and was given a pack”. All individuals viewing or being admitted to the home are given a welcome pack that includes a variety of information about Paisley Court. The home has on-going initiatives including, end of life, nutrition, activity based care, essence of care and sensory garden. These are approaches that make sure that the culture of the home is mainly towards the support, freedom of choice and maintenance of right of individuals living in the. As yet none are fully in place as they involve several years work to become part of the culture of the service. Staff are progressing well in these and are being given the training and support to impact positively on the support of the people living in the home. Individuals are very well protected with thorough good recruitment practices that checks staff suitability before they start working and good information that enables individuals, relatives, visitors and staff to raise any concerns. All concerns are thoroughly investigated. The home treats all incidents as a learning opportunity and uses them to increase the quality of care. Individuals spoken with said, “staff are caring, they take notice of any changes and communicate these whenever we speak with them” and “much happier and calmer here. Staff understand who he is and are approachable and able to meet his needs”. There is a structured training programme via a website that staff can access both in work and in their own homes. Whilst it is expected that the staff will manage this themselves, the management team does monitor how staff are doing via three monthly supervision. Additional to the on-line learning there are in-house practical training sessions to further enhance staff skills. What has improved since the last inspection? Extensive efforts have been made in getting staff to write individual care plans that define how to meet individual needs. This is clearly starting to impact. Care plans seen were much more individual and in some cases very descriptive and clearly showed how to meet individual needs. Other developments with records have included better recording of individual likes and dislikes. Although still in need of further development this is a significant improvement over previous records seen. The service continues to further develop the grounds of the home and these have had significant in put from the people living in the service. There are now a variety of seating areas in place that make sure that individuals can choose what they would like to do when out doors. Other initiatives have included “fresh air week”. This was an initiative to make sure that during the duration of a week every individual was in a position to “feel” fresh air. This included those able to go into the garden to do so and those unable to do so had access to items that moved in the air as examples. The manager explained that this was Paisley Court DS0000025191.V365198.R01.S.doc Version 5.2 Page 7 a great success and is looking at ways to use this within every day activities as part of each individual’s daily routines. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Paisley Court DS0000025191.V365198.R01.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 Paisley Court DS0000025191.V365198.R01.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): Standards reviewed: 1, 2, 3 and 4. Standard 6 is not applicable. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. All individuals moving into the home have an assessment that identifies their needs. This is done in order for the staff to determine and plan how they will meet individual needs. EVIDENCE: Paisley Court has an information guide that has a lot of details included in it. We looked at this and evidenced that as yet it does not contain all the information that is needed to guide both people living in the home or staff. A pack of information is given to all people looking around the service or moving in. This includes a copy of terms and conditions of living in the home. Surveys sent to the home showed that in general all people receive a copy of this information. One person explained that although they had a copy of terms and conditions to date this had not been completed. Paisley Court DS0000025191.V365198.R01.S.doc Version 5.2 Page 10 All Individuals are assessed before the move in the format of this remains relatively unchanged from previous inspections. As a large organisation Care UK has several homes and this has lead them to develop a general assessment for managers to use. Paisley Court is a support service for people with complex emotional and psychological needs. The assessments process available leans towards assessing physical needs as a priority. The deputy manager and the manager carry out all assessments , both these individuals are very aware of the services. The assessments available briefly look at issues of equality and diversity such as religion and ethnicity of individuals, although not all areas of equality and diversity are explored. Surveys received by us evidenced, four said they had received a contact, two people said they had not received a contract. One individual said “was given a pack in which there was a contract be we never got a completed one”. Al six surveys returned said yes they had received enough information one said “we really didn’t have a choice there is nowhere else”. Paisley Court is the only health service funded establishment of its kind in the area. Individuals staying for a short time on the respite unit have a full assessment the first time that they move in. The manager explained that each time they return a telephone assessment is done to see what has changed and how the home needs to respond to changes. A staff member working on the respite unit was not aware of this process as such they were not aware if an updated assessment had been done before the person returned for their stay. Each individuals living in the home is allocated a key worker. The home attempt to make sure that the key worker is available on duty when the person arrives. This provides continuity of care and a point of contact for individuals and their relatives. Paisley Court DS0000025191.V365198.R01.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): Standards reviewed: 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management of medications continues to improve. Staff are not always following the homes policy and procedure and need to make sure that they do this in order to maintain safe standards. Individual health, personal and social care needs are in the main recorded, this is variable in standard with some staff writing very clear guidance to follow and other care plans in need of further details. EVIDENCE: We looked at a five care plans. Paisley Court has all their care plans on computerised system. Staff write the care plans on the computer and make daily notes regarding the support given to the individual. The daily notes varied in quality in some instances very clear and meaningful information, in other instances phrases such as “Safety maintained” and “reassurance given by staff”. These notes do not detail what actions staff have taken, why or what Paisley Court DS0000025191.V365198.R01.S.doc Version 5.2 Page 12 effect they had and therefore does not clearly detail that the care plan in places effective or what changes need to take place. The key nurse reviews the care plans every month and the system alerts the nurse if they are not done. All care plans that we reviewed had been regularly reviewed. In some cases changes had not been used to update the care plans and actions that were out of date were still in place. In general most of the details within the plans were up to date. An example included a clearly written plan for an individual with diabetes, this clearly explained what medications they needed, how and when to monitor their condition and what to do if the condition changed. At the last site visit it was identified that care plans regarding medications prescribed on a per required needs basis, were not explored within the care plan. This had been addressed in one of the plans but had not been detailed in others. A review of medication records also showed that this information was not available in any written records and as such staff did not always have the information they needed to give out when required medications. Records were kept after visits from external professionals such as doctors, consultants, dentists and opticians. This generally described the purpose of the visit and any recommendations for the staff to carry out, in some cases instructions had been used to update the care plans. Care plans are audited to see if they have been reviewed the deputy manager and manager explained that they had noticed some of the minor issues detailed at this site visit. The ABC philosophy that will influence care planning and daily records is still in its early stages. Staff spoken with were still “getting to grips” with this change. The home has a policy and audit in place for managing medications, this has impacted positively on the management of medications, which were audited and found to be given as prescribed. Two minor issues were noted regarding medication management a patch had been signed as given the day before but was not in place on the day of the site visit and a daytime medication had been given at night. The medication was the same dose and the individual had used the wrong medication pack. Both these instances show that staff need to make sure that they stick to the homes policy and procedure. The medications records were two days old and showed that both these instances had occurred within the last two days. As detailed in the last site visit care staff applied external preparations, these are generally being signed for by the nursing staff who did not give out the cream. There were no instructions available to care staff as to how, when or where they were to be applied. Guidance for staff undertaking care activities needs to be readily available and in writing. Verbal communications only run the risk of being actioned incorrectly. Surveys received showed that regarding do you always get the care and support you need four individuals said always. Comments were “Dad has received the best care so far”, “This is a good home they listen properly”. One person replied they usually receive the correct care and support. One person said sometimes. Comments included “Not all the staff are aware of what dad can do, some staff significantly better at communication than others”. Paisley Court DS0000025191.V365198.R01.S.doc Version 5.2 Page 13 When asked do staff listen and act on what you say. Five people said yes comments were, “Staff are caring and take notice of the changes in dad” and “Staff are well able to see any changes and make sure that they deal with any changes”. One person said not always comments were “I think mum isn’t always able to say what she needs and staff often guess. They don’t always take the time to recognise what she is saying”. The majority of people were evidenced as happy with the care they received. Evidence suggests that a little more time with one of the people living in the home would benefit them. The expert by experience observed a number of individuals in the lounge area of one of the units. They appeared comfortable with their surroundings and showed good responses in their interaction with understanding care staff. He was introduced to one gentleman who, when asked how he was replied with an alert, “very well, thank you”. All of the four units that make up the home are based on the same design so it was with ease that we moved through the home affording me chance to interact with a variety of relaxed residents going about their daily activities in safety. He saw a number of ladies who looked lovely having just been visited by the hairdresser and others who were eagerly awaiting the hairdresser’s attention. Paisley Court DS0000025191.V365198.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards reviewed: 12, 13, 14, and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service continues to develop opportunities that meet individual’s choices and preferences. EVIDENCE: Lunchtime on the respite unit was observed, all meals were transported and served from heated trolleys with individuals served promptly and considerately by the staff. Staff took good actions to meet individual such as cutting meat to smaller portions. Staff stated that menus are decided on with input by the people living in the home. They also stated that personal likes and dislikes were both recorded and taken in to account at meal times. We looked at records regarding personal preferences and choices and evidenced that this has significantly improved from previous site visit. Staff are now recording some of the individuals choices. The quality of these records are variable with some staff recording a good overview of different preferences and activities plan. Whilst in other instances there was minimal recording and no plan of activities. Staff stated that individuals are asked what meals they would prefer Paisley Court DS0000025191.V365198.R01.S.doc Version 5.2 Page 15 to eat. This can become more difficult for a number of individuals who are less able to communicate verbally. In these instances staff rely on what is know of their preferences to assist in making decisions. Without good clear records that keeps staff up to date and informed it is not possible that choices and preferences will always be accurate. Returned surveys gave us the following information. When asked do you like the meals. Four said always comments such as, “dad has put on weight and always supplied with drinks” and “I really like the food, its tasty”. were made. One said usually and one sometimes comments included, “food is okay sometimes, but it can be a bit boring”, “some cooks are better than others” and “the meals are okay but mum often says she’s hungry there doesn’t appear to be any snacks”. One individual has a different culture to the majority of the people living in the home. Staff had obtained three key phrases in their primary language to assist with communication. The individuals care plan contained no information regarding their equality and diversity needs and an activities plan did not detail their involvement in any culturally related or religion based activities. Staff spoken with said that they would like more information regarding the individual’s cultural needs. In general most of the individuals enjoy the food provided. Several relatives were spoken with. One visitor was sitting with his mother watching television in her room. He expressed his heart felt relief and gratitude with the standard of care that his mother enjoys. Another individual’s family members were spoken with. The individual had already stated that they “had enough to do” throughout the day and that he was “alreet meself”. Their family were happy with the standard of care and said, “oh gosh yes” and that medication, staff and management were “spot on”, but she did have some doubts about the availability of daily activities for individuals, suggesting that more board games might be made available. The manager explained that there are a number of board games available but frequently the pieces go missing. A pack of activities is placed on each unit by the activities co-ordinator, this can included games, painting activities etc. On the day of the site visit the paintbrushes for one unit had gone missing. Activities can not occur appropriately if care is not taken to make sure that the equipment is available at all times. Observation during the day showed that in one lounge seven individuals were sitting a television was on in a corner. Three staff were in the room at the time. Four of the seven individuals were asleep in their chairs, no activities other than the television were observed. The homes ABC states that if the television is not being watched staff need to interact in a different way such as music. ABC is a new initiative that will take time for staff to fully use on a daily basis as this prompts a cultural change and asks different things from staff than they are used to. Paisley Court DS0000025191.V365198.R01.S.doc Version 5.2 Page 16 Returned surveys gave us the following information. When asked are there activities arranged that you can take part in, two individuals said always one comment made was “staff go through memory book that is really helpful”. Two said usually, one said sometimes and one said never. Comments included “not able to join in organised activities”, “the organised activities don’t meet his needs they don’t seem to have something straight forward. Mum just can’t do stuff with two many people and hasn’t the attention to do something”, “would like to get out more and “I have never seen any activities is appears to be television sit in the garden or sleep”. Activities are still not yet fully developed to meet all individual needs. We observed one individual completing an activity with the activities coordinator. They excitedly told the home manager and us how proud they were of their product (garden chimes) and set about hanging them in the garden. At the request of an individual living in the home a section of the garden had been used to create a religious shrine. The manager explained that the advent of this shrine had lifted the spirits of the individual who attend it twice a day. Paisley Court DS0000025191.V365198.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards reviewed: 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people living in the home, relatives and staff are able to raise concerns and have these dealt with. EVIDENCE: We looked at training for staff in reporting complaints and in particular recognising and reporting potential adult abuse concerns. The service has a computerised training system, which allows the senior staff to monitor the progress that individuals are making in their learning. The home manager also provides a face-to-face training session for all staff that also helps management determine staffs understanding. The majority of staff spoken with understood the way that these serious concerns are dealt with. The service has a wide range of policies and procedures that include whistle blowing (a way for staff to raise concerns), raising complaints and protection of vulnerable adults. Staff spoken with had been shown all the policies within this area. The needs of the people living in the service are complex and diverse, this has lead to the occasional difference of opinion between individuals that can occasions be verbally of physically aggressive. There is no process in which the staff can record these and pass directly to social services, which are the responsible authority for any allegations of potential abuse. This means that the service is unsure of what to report to social services in the circumstances were the potential abuse has occurred between to people living in the home. The Paisley Court DS0000025191.V365198.R01.S.doc Version 5.2 Page 18 manager said that if they reported all these instances there would be a substantial amount of work involved. A lack of an agreed arrangement between the service and social services means that not all instances are reported and this could lead to serious concerns of this nature not being addressed appropriately. Paisley Court DS0000025191.V365198.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards reviewed: 19, 20, 21, 23, 24, 25 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home offers a variety of dining rooms, lounges areas and garden area that meets the needs of people living in the home. The opportunity to decorate the establish in a manner more in keeping with the needs of people living in the home has not been fully developed. EVIDENCE: The outside garden space is continuing to be developed. Separate seating areas have been created such as a beach garden with a mural painted on the wall, a woodland area with a three-dimensional painting. Other areas will be turned into outdoor bowling and a gardeners club. Paisley Court DS0000025191.V365198.R01.S.doc Version 5.2 Page 20 The home is divided into four separate units. Each unit has a lounge and a dining room available for the people who live in the home. Each of the individuals are offered an opportunity to personalise their own private space with items that are familiar. Many of the doors have the name of the person living in them. This is in place to help guide individuals into the space that is their own. One person stood in front of the door read the name and said “that my room”. It was evidenced that in some cases the names on the doors certainly does help people to not go in a room that does not belong to them. Several of the doors have “gates” on them. This is to prevent individuals walking into each other’s rooms. In the past the service has tried to reduce these but relatives felt that they helped. It was noticed that there are more gates than on previous visits. These items are not particularly appropriate and do present a restriction on some individuals movements, particularly when they are in their own bedroom with the gate in place. The service has risk assessed the use of these gates. It was not possible to evidence what alternatives such as half doors or locking bedroom doors when individuals not in their room have been considered per individual. We observed on the respite unit that one individual frequently went in and out of other peoples bedrooms. None of the doors were locked, all of the doors were open and this meant that people who do explore will be able to access private space with ease. Some areas of the home have been redecorated, in some areas there were tactile panels that had items that individuals could touch. In general the home is decorated to a reasonable standard. Some elements of information that helps people find their way are available such as names on doors and pictures of a toilet on a bathroom door were available. These were not always of good quality and often the sign was very small. The manager explained that there are plans to have pictures that are the size of the door of items such as a toilet or knife and fork for dining room, this will be more in keeping with helping orientate individuals to the environment that they live in. There are also plans to make some areas of the home a little more homely as some of the decoration and flooring is not as you would find in an individuals own home. There are ample bathrooms for the use of the people living in the home. Paisley Court DS0000025191.V365198.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff have received training to make sure that they develop the skills that they need to support individuals living in the home. EVIDENCE: The home has full recruitment policy and procedure. A number of staff files were reviewed, these evidenced that all staff had undergone full and proper recruitment including references, police checks, and suitability to work with vulnerable adult’s before they started work. The recruitment is done taking into account the equality and diversity needs of any potential staff. We looked at staff files, these were well organised with clear evidence that the fitness of each staff member has been checked before they are able to work in the home. A good induction is in place that is monitored by the management team, this covers essential issues and training is included to make sure that staff have the skills that they need to work in the home. Large parts of training has now been put onto a computer system, there are standard items that all staff must complete and the system shows if they have not done so, this includes specific items such as fire training. There is also an on-line learning programme that staff can access from work or from their own homes. It is the responsibility of the staff to keep themselves up to date and Paisley Court DS0000025191.V365198.R01.S.doc Version 5.2 Page 22 the deputy manager regularly monitors it. Staff are given the opportunity to do the training but if they fail to do so action is taken in line with the homes disciplinary policy. This is good practice as it makes sure that keep themselves up to date. There is a variety of training a variety of training available, such as health and safety and fire training. The computerised system is from the homes main head office and as such is the overview of training that is needed for all the homes. This means that it does not yet record training that staff need for the specific needs of individuals. There is no specific equality and diversity training in place for staff or training to meet specific equality and diversity needs. One individual is of a different ethnic background to the majority of the people living in the home. Staff spoken with all said that they would like a better knowledge to help meet the individual’s cultural needs. The homes ABC system does not yet carry any specific training that will guide staff fully once this is in place staff will have a clearer understanding of how this will impact on the care that they provide. There is other on-site training such as moving and handling and protection of vulnerable adults, this is done to make sure that staff also receive the practical skills that they need. The home had a full assessment of the individuals in the home needs to determine the correct staffing level a few years ago. This is good practice but should be continued on a regular basis as individual needs may have changed. Paisley Court DS0000025191.V365198.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Progress continues to be made in several areas including medications, training, activities and care plans. Arrangements are in place for the management of individual funds that safeguards their interests. EVIDENCE: The home has its own quality assurance scheme in place that is done by the head office of the company. Additional quality assurance is done within the by the management this includes auditing of care plans and medications. Since this has been put into place improvement has been noticed in both these areas with both medications now managed safely and care plans having better details in them. Paisley Court DS0000025191.V365198.R01.S.doc Version 5.2 Page 24 All staff receive a regular supervision with their manager. This is done to make sure that they are supported to do their jobs and that any areas of learning that they wish to take are identified. The manager is registered with the commission and has extensive experience. She is qualified as a mental health nurse and has a deputy with qualifications in general nursing. Between them they have a good mix of skills and experience. None of the people living in the home pay for their care and as such the home does not hold personal allowances for them and therefore is not appointee for any of the individual. An account is held in head office, which contains some funds deposited by relatives and a small amount is available in the home. Access to the small amount on site is to be available at all times to make sure that individual are not restricted from accessing their own money. All spending has receipts available and records are kept that shows the amount of funds each individual has. The home holds very small amounts of money only and most of the time this is given directly to the individuals for them to spend themselves. Certificates of maintenance were available and all up to date, maintenance records clearly detail all maintenance issues addressed. Health and safety training is available for staff and they are monitored to make sure that they complete the appropriate health and safety training. Paisley Court DS0000025191.V365198.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 3 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 2 2 3 3 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 X 3 Paisley Court DS0000025191.V365198.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No 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 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 RCN Good Practice Recommendations Arrangements for equality and diversity need to be better explored including information in assessments, training for staff and policies and procedures in place that support staff. The service users guide needs to reviewed and updated in line with schedule 1 of the Care Homes Regulations 2001. Staff needs to have clear guidance on per required need medications and the use of external preparations such as creams. These need to have clear instructions available, the service needs to determine the best way to do this and put it into action. Guidance for the use of per required need medications is best recorded in individual care plans. Staff need to make sure that they follow the homes policy and procedure for medications at all times. The service should make arrangements to make sure that their ABC is full developed and implemented. Staff need support and training in order to make sure that they fully DS0000025191.V365198.R01.S.doc Version 5.2 Page 27 2. 3. OP3 OP9 4. OP14 Paisley Court 5. OP19 6. OP27 understand how this impacts on the role. Exploration as to alternatives to the use of gates on bedroom doors needs to be undertaken. Areas of the environment that need to be increased in line with best practice for the needs of the people living in the home such as larger signs and ways to clearly identify personal space needs to be reviewed. Staffing levels need to be regularly reviewed to make sure that there is enough staff at all times to meet the needs of individuals. Paisley Court DS0000025191.V365198.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Merseyside Area Office 2nd Floor South Wing Burlington House Crosby Road North Waterloo, Liverpool L22 OLG 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 Paisley Court DS0000025191.V365198.R01.S.doc Version 5.2 Page 29 - 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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