Inspection on 21/05/08 for The Towans

This is the latest available inspection report for this service, carried out on 21st May 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.

Other inspections for this house

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE The Towans The Towans Berrow Road Burnham on Sea Somerset TA8 2EZ Lead Inspector Kathy McCluskey Unannounced Inspection 21st May 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 The Towans DS0000067036.V363897.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. The Towans DS0000067036.V363897.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Towans Address The Towans Berrow Road Burnham on Sea Somerset TA8 2EZ 01278 782642 01278 782762 marie@towans.co.uk 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) Towans Care Ltd Marie Louise Drewett Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28) of places The Towans DS0000067036.V363897.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home providing personal care only - 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 28. 27th September 2006 Date of last inspection Brief Description of the Service: The Towans is a large two-storey property, set in spacious and well-maintained gardens. The Home is in a residential area, set back from Berrow Road at the end of a drive, with sea views to the rear of the property. The centre of Burnham-on-Sea (with local amenities) is approximately half a mile away. Extensions have been added to the original house. There is a passenger lift, as well as the main staircase, giving access to different parts of the Home. The Home is registered with the Commission for Social Care Inspection to provide accommodation to up to twenty-eight people over the age of 65 years, who require assistance with personal care. The home is not registered to provide nursing care or care to people whose primary care needs are dementia. Additionally, a day care service is offered at the Home (such services are not registered or regulated by the Commission). The current fee range is £390 to £550 per week and this is dependant on the room occupied. Additional charges are met by the individual for: hairdressing, personal toiletries/clothing, newspapers, chiropody and private telephone lines. The Towans DS0000067036.V363897.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience Good quality outcomes. The focus of this inspection visit was to inspect relevant key standards under the Commission’s ‘Inspecting for Better Lives 2’ framework. This focuses on outcomes for service users and measures the quality of the service for each outcome group under four general headings. These are; - excellent, good, adequate and poor. This unannounced key inspection was conducted over one day (7hrs) by regulation inspector Kathy McCluskey. The registered manager and the registered provider were available throughout this inspection. At the time of this inspection we were informed that 25 people were living at the home and during our visit, we were able to meet with the majority of them. We also spoke with three staff and one visitor. Comments have been included throughout this report. We observed staff interactions with people using the service and were able to see lunch being served. We were given unrestricted access to all parts of the home and all records requested for this inspection, were made available to us. A selection of records were examined relating to staff, people using the service, and health and safety. We would like to thank all involved, for their time and cooperation with the inspection process. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. What the service does well: The Towens provides a very homely and well maintained environment. People have access to large and beautifully maintained gardens. All bedrooms are spacious and exceed the National Minimum Standards for size. People are able to personalise their bedrooms. The Towans DS0000067036.V363897.R01.S.doc Version 5.2 Page 6 People who are thinking about moving to The Towans are provided with very detailed information about the home and are also encouraged to visit the home before making a decision to move there. The home also offers a respite and day care service. The home ensures that nobody moves to the home before they have been assessed. This is to ensure that the home can fully meet the assessed needs and aspirations of the individual. The home is managed by a competent and experienced registered manager. A plan of care is developed for each person, which takes into account individuals needs and preferences. These are regularly reviewed and the home ensures that each person has access to appropriate healthcare professionals. People living at the home told us that the staff were kind and respectful. People told us that they ‘liked’ living at the home and felt ‘well cared’ for. People said; ‘they know what I like and what I don’t like’, ‘The staff will do anything for you’, ‘It is a wonderful place and I feel very well cared for’, ‘If I can’t be at home then this is where I want to be’. The home employs two staff members who are responsible for organising activities in the home. During discussions with people at the home, they told us that; ‘There is always something going on’, ‘I like the quizzes and the bingo’. People also told us that the activity staff would come and have a chat with them. People told us that they could choose how and where to spend their day. The home ensures that the preferences of individuals’ are ascertained and recorded. The home offers a wholesome and varied menu. People told us that meals at the home were; ‘Very good’. They said that ‘there is always plenty to eat’ and ‘They know what I like’. People confirmed that snacks would be made available on request. Appropriate procedures are in place to enable people to raise concerns. People told us that they would feel confident in raising concerns if they had any. The home have a stable staff team who have been appropriately trained. Staff morale appeared very good and there was a ‘happy’ atmosphere in the home. People living at the home told us that the staff were ‘wonderful’ and ‘would do anything for you’. When asked, people confirmed that their call bells were responded to promptly by staff. People felt that their needs were met by staff. Appropriate procedures are in place and followed to reduce the risk of harm or abuse to the people living there. Robust staff recruitment procedures are in place. The Towans DS0000067036.V363897.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? 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. The Towans DS0000067036.V363897.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 The Towans DS0000067036.V363897.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): 1, 2, 3 & 5 – Standard 6 is not applicable as the home is not registered to provide intermediate care. Quality in this outcome area is Excellent This judgement has been made using available evidence including a visit to this service. People are provided with the information they need to enable them to make an informed decision about moving to the home. The home ensures that people are fully assessed prior to a placement being offered. People are given the opportunity to ‘test drive’ the home before making a decision to move there. EVIDENCE: The home has produced a very detailed Statement of Purpose and brochure, which provides information about the home and the services offered. The Towans DS0000067036.V363897.R01.S.doc Version 5.2 Page 10 The brochure was seen to be displayed in the reception area of the home. This had been produced using larger print and had incorporated various photographs. We spoke to two people who had recently moved to the home. They confirmed that they had been given information about the home, which helped them to make a decision to move there. We were able to see a copy of the home’s contract. This contained detailed information about the charges and terms and conditions of occupancy. The home ensures that people are appropriately assessed before a placement is offered. A pre-admission assessment is used to ascertain whether the home can fully meet the assessed needs and aspirations of the individual. We were able to see evidence of completed assessments in the three care plans examined at this inspection. We were also able to see that the home had obtained assessments from appropriate healthcare professionals where available. Two people who had recently moved to the home told us that they were given the opportunity to visit the home prior to making a decision to move there. One person told us that their relative had visited the home on their behalf. In the home’s Statement of Purpose it states that the first four weeks of admission is considered a trial period. The home also offers a day care and respite service. One person living at the home told us that they had decided to stay at the home on a permanent basis after using the respite facility. The Towans DS0000067036.V363897.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): 7, 8, 9 & 10 Quality in this outcome area is Good This judgement has been made using available evidence including a visit to this service. The home’s care planning procedures are good and information available helps to promote a person centred approach to care. People are well cared for and the home ensures that they have access to appropriate healthcare professionals. The home’s procedures for the management and administration of peoples’ medication have improved though further improvements have been recommended. People are treated with respect and their right to privacy is upheld. EVIDENCE: The Towans DS0000067036.V363897.R01.S.doc Version 5.2 Page 12 At this inspection we examined the care records of three people living at the home. Care plans contained up to date assessments, which included; reducing the risk of falls, nutrition and moving and handling. We were able to see that care plans had been raised where an assessed need had been identified. Care plans contained clear information about the individuals assessed needs and also contained detailed instructions for staff as to how needs should be met. The preferences of the individuals had been included in the plan of care. This helps to promote a more person centred approach to care. We were able to see that people had access to appropriate healthcare professionals. The home records a person’s contact with a healthcare professional in the plan of care. One of the care plans examined contained documentation of a recent review with their care manager. During this inspection we met with a relative who described the care provided to their relative as ‘marvellous’, ‘we can’t fault it’. Care plans examined contained evidence that peoples’ weights are recorded on a monthly basis. We were able to see that a care plan had been raised for one person with a significant weight loss. Advice from a dietician had been sought and appropriate healthcare professionals had been alerted. During this inspection we were able to speak with the majority of people living at the home. People told us that they ‘liked’ living at the home and felt ‘well cared’ for. People said; ‘they know what I like and what I don’t like’, ‘The staff will do anything for you’, ‘It is a wonderful place and I feel very well cared for’, ‘If I can’t be at home then this is where I want to be’. Care plans contained evidence that individuals or their representatives, had been involved in the care planning process. We examined the home’s procedures for the management and administration of people’s medication. The home uses the Boots monitored dosage system (MDS) with pre-printed medication administration records (MAR). We examined all available MAR charts and found these to be generally well completed. At the last inspection it was noted that there were gaps in signing for medication prescribed, at this inspection we found no gaps. On three occasions, two signatures had not been obtained to confirm hand written entries on the MAR chart. A recommendation has been raised as this will assist in reducing the risk of errors. We were able to see evidence that, as required at the last inspection, the home is maintaining appropriate records relating to the administration of prescribed creams. Creams in use had been marked with the date opened. The home needs to ensure that this practise is followed for all items with a limited shelf life as we noted that this was not the case for eye drops in use and an opened decanted liquid. The registered manager gave her assurances that this would be addressed. The Towans DS0000067036.V363897.R01.S.doc Version 5.2 Page 13 Some controlled drugs are in use and we looked at records relating to two people. Records had been appropriately completed balances tallied with the stocks held. The home checks all controlled drugs at the end of each shift. Records were available to confirm this. All medicines were found to be securely stored. We were informed that medicines are only administered by senior care staff who have received up to date training from the dispensing pharmacy. The home maintains sample signatures and initials for these staff. Appropriate procedures are followed for the receipt and disposal of medicines. Records were available to confirm this. We were able to see that, as appropriate, people are supported to manage their own medicines. Completed risk assessments were available for two people and we were able to see that secure storage was available for people to store their medicines safely in their bedrooms. It has been recommended that the home records the amount of medicines given to people for self-medication and that signatures are obtained as this will help to provide a clear audit trail of all medicines held in the home. During the inspection we were able to speak with some staff and the majority of people living there. We were also able to make observations throughout the day. We noted that people looked relaxed and comfortable in the presence of staff and the management team. Interactions were kind and respectful and staff were observed assisting people in an unhurried manner. Staff addressed people in their preferred form of address and were warm and professional in their approach. People told us that staff respected their privacy; ‘They know that I like to stay in my room and don’t like to be bothered too much’. We saw that staff knocked on peoples’ bedroom doors before entering and that post was passed on unopened. The Towans DS0000067036.V363897.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): 12, 13, 14 & 15 Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. People can choose how and where to spend their day and their wishes are respected by the home. The home ensures that people have the opportunity for social stimulation. People are supported to maintain contact with their family and friends and visitors to the home are made to feel welcome. The home offers a wholesome and varied menu. Choices are available and special diets/preferences are catered for. EVIDENCE: The home employs two activity co-ordinators who work Monday to Friday. We were able to meet with one member of staff during this inspection. Through discussion with the staff member and during observations, it was apparent that the staff member was committed to ensuring that people had the opportunity for social activities and stimulation. People were observed responding in a very The Towans DS0000067036.V363897.R01.S.doc Version 5.2 Page 15 positive way to the staff member and many joined in with the game of ‘Quoits’ during the afternoon. During discussions with people at the home, they told us that; ‘There is always something going on’, ‘I like the quizzes and the bingo’. People also told us that the activity staff would come and have a chat with them. One person who chooses to remain in their room, told us that the staff member had ‘had a chat with me today’. Care records examined at this inspection contained information about individuals’ social history. The activities person told us that she always had a chat with people to ascertain their preferences. People told us that they could choose how and where to spend their day. During this inspection people were observed moving freely around the home. Some people chose to spend the majority of the day in their rooms. One person was observed spending time in the attractive gardens. People told us that they could choose what time they got up in the morning and what time they go to bed. Preferences had been recorded in the care plans examined. Through discussion with people living at the home, it was apparent that their visitors are made to feel very welcome. The majority of people we met with told us that their visitors can to the home several times a week. People told us that they could choose where to see their visitor and that; ‘they are always offered a drink and biscuits’. One relative spoken with told us that they were always made to feel welcome at the home and could visit at any time. To comply with fire safety regulations, all visitors to the home are required to sign in and out. One person living at the home was observed greeting their visitor at the front door and asking them to sign the visitors book. We were told that one person was currently using the services of an advocate. The registered manager stated that she would obtain these services for any person who required or requested it. People told us that meals at the home were; ‘Very good’. They said that ‘there is always plenty to eat’ and ‘They know what I like’. People confirmed that snacks would be made available on request. We observed staff offering one person additional snacks in line with their plan of care. People told us that choices were always available. During the morning we observed a member of staff asking people about their preferences for the following day. When asked, one person told us that ‘you can always change your mind if you like’. We were able to see lunch being served in the spacious dining room. Comfortable seating was available and tables had been attractively laid. The Towans DS0000067036.V363897.R01.S.doc Version 5.2 Page 16 Condiments and napkins were available. People had access to a choice of cold drinks and tea and coffee was offered after the meal. The meal looked appetising and plentiful. A staff member was observed offering assistance to one person in an unhurried and dignified manner. Menus examined appeared wholesome and varied. There was good use of fish, meat and vegetables. All meals are prepared and cooked at the home by the home’s cooks. The Towans DS0000067036.V363897.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): 16 & 18 Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. People feel confident in raising concerns and that the home will take appropriate action. The home has appropriate procedures in place to reduce the risk of harm or abuse to people living at the home. EVIDENCE: The home has a complaints procedure which is displayed in the reception area of the home. No concerns or complaints have been raised with the Commission since the last inspection and we were informed that no complaints have been received by the home. During this inspection we spoke to the majority of the people living there. Nobody raised any concerns with us and people said that they would feel confident in raising concerns with the home if they had any. People also told us that they felt confident that the home would respond to any concerns they might raise. The Towans DS0000067036.V363897.R01.S.doc Version 5.2 Page 18 The home has procedures available to staff relating to raising concerns. When we spoke to staff they also confirmed that they would feel confident in raising concerns if they had any. One staff member spoken with confirmed that they were aware of how to contact external agencies if required. At the time of this inspection we found that the home was following appropriate procedures to reduce the risk of harm or abuse to people living at the home. The registered provider and registered manager confirmed that they had an up to date copy (May 2007) of Somersets Safeguarding Adults Policy. The registered manager confirmed that the staff induction programme covered the protection of vulnerable adults. Staff training records contained evidence that staff had received training in the protection of vulnerable adults earlier this year. The home has a policy for staff relating to the acceptance of gifts. This also includes a statement which precludes staff from accepting gifts and of being involved in drawing up, or benefiting from a persons will. The home follows robust staff recruitment procedures which include checks against the Criminal Records Bureau (CRB) and the Protection of Vulnerable Adults register (POVA). The Towans DS0000067036.V363897.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): 19, 20, 21, 22, 23, 24, 25 & 26 Quality in this outcome area is Excellent. This judgement has been made using available evidence including a visit to this service. The home provides a very spacious and comfortable ‘homely’ environment and people have access to very large gardens which are beautifully maintained. People are able to personalise their spacious bedrooms. The home has a good range of aids and adaptations available to assist people to mobilise. Appropriate procedures are in place to reduce the risk of the spread of infection. EVIDENCE: The Towans DS0000067036.V363897.R01.S.doc Version 5.2 Page 20 The Towans is situated in a quiet area not far from the town centre and sea front. The home is situated within its own very large and beautifully maintained gardens. Rooms look out on to either the sea or the gardens. During this inspection we were given unrestricted access to all areas of the home. We found the home to be well maintained, pleasantly decorated and very comfortably furnished. People benefit from a choice of communal areas which include a very large lounge, smaller lounge and conservatory. There is also a very spacious dining room. Space available exceeds the minimum recommendations of the National Minimum Standards for Older People. During the inspection people were observed utilising all communal areas and they appeared very comfortable in their surroundings. People told us that; ‘The atmosphere is just right and it is very homely’, ‘I don’t think that you could find a better home’. The registered person advised that the home has a programme of refurbishment, which is on-going. Several improvements have been made to the environment since the last inspection which include the complete refurbishment of one bathroom and the installation of a ‘wet room’. The registered provider informed us that there were plans to refurbish a downstairs bathroom this year. Assisted bathing facilities are available which include an assisted bathroom on the ground floor (due for refurbishment) and a newly refurbished assisted bathroom on the first floor, The home also has a newly installed ‘wet room’ for those who prefer a shower. The home has 26 bedrooms and all but 3 are fitted with en-suite toilet facilities, 2 bedrooms also have the provision of a shower. The home has been suitably adapted to meet the needs of people with mobility difficulties. Grab rails and ramps are appropriately sited throughout the home. A passenger lift gives access to the first floor for those unable to manage stairs. The home is fitted with a call bell system. Call bell ‘Pendants’ are available to people who require them. The home has a mobile hoist and stand aid available to assist people as required. To ensure the safety of people living at the home, upstairs windows have restricted openings and radiators are fitted with a guard. Hot water outlets are fitted with thermostatic controls to ensure that temperatures remain within safe limits. During this inspection we viewed four bedrooms. These were found to be very comfortable and pleasantly furnished. It was apparent that people were encouraged to personalise their private space. People told us that they were ‘very happy’ with their bedrooms. The Towans DS0000067036.V363897.R01.S.doc Version 5.2 Page 21 The home’s Statement of Purpose shows that all bedrooms exceed the National Minimum Standards for size. The smallest room is identified as 13m2, the largest being just over 28m2. One bedroom can be utilised as a double bedroom if required. During a tour of the home, we were able to see that appropriate systems were in place to reduce the risk of the spread of infection. Liquid soap and paper hand towels were appropriately sited and there was a good supply of protective equipment for staff. All areas of the home seen during this inspection were noted to be clean and free from malodours. The Towans DS0000067036.V363897.R01.S.doc Version 5.2 Page 22 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 Good. This judgement has been made using available evidence including a visit to this service. Staffing levels are satisfactory but consideration should be given to increasing these during the tea time period. Staff are supported to develop their skills through National Vocational Qualifications (NVQ). The home’s procedures for the recruitment of staff have improved. Systems are in place to ensure that staff receive the training they need. EVIDENCE: We were informed that the home has a stable staff team with a low staff turnover. The registered manager stated that the home had not had to use agency staff for the last 18 months. The registered manager advised us that staffing levels were sufficient to meet the current needs of people living at the home. We were informed that staffing levels are as follows; AM – 1 senior carer and 3 care staff PM – 1 senior carer and 2 care staff The Towans DS0000067036.V363897.R01.S.doc Version 5.2 Page 23 Night – 2 waking care staff. The registered manager works during the week in addition to the care staff. The home also employs activity staff, cleaners and kitchen staff. People living at the home told us that the staff were ‘wonderful’ and ‘would do anything for you’. When asked, people confirmed that their call bells were responded to promptly by staff. People felt that their needs were met by staff. On the day of this inspection, staff morale appeared very good and there was a ‘happy’ atmosphere within the home. Staff told us that they were able to meet peoples’ needs with the number of staff on duty but that sometimes, ‘it is very busy’. Staff said that they experienced difficulties at tea time as they were responsible for making any meals not already prepared by the cook and for serving and clearing up. They told us that although they ensured they followed infection control procedures, they did not feel that it was appropriate to move from the kitchen to assisting people who needed assistance. They also said that it was ‘frustrating’ that they were not readily available during this time, when people needed them. We discussed this with the registered provider and registered manager at the end of the inspection. The registered provider indicated that this was something that she was currently considering. Staff confirmed that they had received sufficient training to enable them to meet the needs of the people living at the home. They also confirmed that they had received appropriate mandatory training such as moving and handling and fire safety. The registered manager maintains good records relating to staff training and she confirmed that she has a system in place to ensure that mandatory training is updated as required. Two care staff spoken with informed us that they had been supported to obtain an NVQ Level 2 in care and one was working towards an NVQ level 3. Information made available to us by the home told us that, of the 19 care staff employed, 11 had achieved a minimum of an NVQ level 2 in care. This equates to 58 which exceeds the recommendation of the National Minimum Standards for Older People of 50 . We examined the home’s procedures for the recruitment of staff. At the last inspection a requirement was raised relating to references and employment history. Two staff recruitment files were examined relating to staff recently employed. Files contained all required information. There was evidence that appropriate references had been obtained prior to employment. Application forms contained appropriate information about employment history which would enable the home to explore any gaps in employment. The home had also obtained appropriate checks with the Criminal Records Bureau (CRB) and Protection of Vulnerable Adults register (POVA). The Towans DS0000067036.V363897.R01.S.doc Version 5.2 Page 24 There was evidence that staff complete an induction programme on commencement of employment and we were informed that the two staff members were currently completing the 12 week induction programme which follows the Skills for Care Common Induction standards. The Towans DS0000067036.V363897.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37 & 38 Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. The registered manager has the skills and experience necessary to manage the home. The home has quality assurance systems in place which seek the views of the people living there. This could be further improved by introducing regular meetings. Appropriate procedures are followed to ensure the safe management of peoples’ monies. Staff are appropriately supervised. At the time of this inspection, the home is taking appropriate steps to ensure the health and safety of persons at the home. The Towans DS0000067036.V363897.R01.S.doc Version 5.2 Page 26 EVIDENCE: An application for Marie Drewitt to be registered manager of the home was approved by the Commission in April 2007. The registered manager has an NVQ level 2 & 3 in care and has completed an NVQ level 4 in management. She has over 10 years experience of working in the care sector. When we spoke with the registered manager it was apparent that she had a good knowledge and understanding of the needs and preferences of people living at the home. People living at the home said that they found her ‘friendly and approachable’. During the inspection we observed the registered manager spending periods of time with the people living there. The home has quality assurance systems in place which seek the views of people who live at the home and their representatives. We were able to view a number of completed questionnaires, which had been recently completed. Responses to questions were generally scored under the heading of ‘good’ or ‘excellent’. We asked people if they were offered the opportunity to attend meetings at the home. They told us that they didn’t have meetings. They said that they speak to staff on a daily basis. We suggested that the home consider offering people regular meetings. The last staff meeting was held in March 2007. It has been recommended that more frequent meetings are arranged as this is something staff indicated that they would like. The home manages small amounts of money on behalf of the people living there where required. We were informed that the home does not act as financial appointee for anybody living at the home. The home maintains appropriate records for all transactions. Two staff members sign for all transactions and receipts are maintained. We were informed that only the registered manager and senior staff have access to peoples’ money. Balances were not checked at this inspection. Records examined demonstrated that staff received formal supervision sessions. This was also confirmed by staff spoken with. A staff member also stated that they had received an annual appraisal. During this inspection, we were able to see evidence that the home is taking appropriate steps to ensure the health and safety of persons at the home. We ascertained this by a tour of the premises, discussion with staff and the management team and on examination of a selection of records; The Towans DS0000067036.V363897.R01.S.doc Version 5.2 Page 27 FIRE SAFETY – Records examined confirmed that the home was carrying out weekly checks on the home’s fire alarm systems and monthly checks on the emergency lighting systems. Annual servicing by an external contractor was last carried out on 08/04/08. Staff spoken with stated that they had received recent training in fire safety. Training records examined also confirmed this. GAS SAFETY – The home has an up to date annual Landlords gas safety certificate dated 21/09/07. EQUIPMENT SERVICING RECORDS – records were available to confirm that 6 monthly servicing had been carried out on 13/12/07. REDUCING THE RISK OF BURNS/SCALDS – Hot water outlets are fitted with thermostatic valves to ensure that temperatures do not exceed safe upper limits. The home conducts monthly checks on all outlets. All radiators are fitted with a guard. To reduce the risk of injury to people living at the home, upstairs windows are fitted with a restrictor. The home maintains appropriate records relating to accidents. A sample were viewed at this inspection. No concerns were noted. The registered provider and registered manager confirmed that they discussed accidents on a monthly basis but that records of this are not maintained. It has been recommended that a formal system of analysing accidents is introduced so that any traits can be easily identified. The Towans DS0000067036.V363897.R01.S.doc Version 5.2 Page 28 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 4 3 3 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 4 3 3 4 3 3 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 3 x 3 The Towans DS0000067036.V363897.R01.S.doc Version 5.2 Page 29 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 OP9 Good Practice Recommendations To reduce the risk of errors, the registered person should ensure that all hand written entries on medication administration records are confirmed by two staff signatures. To enable a clear audit trail, the registered person should ensure that the amount of medicines passed to an individual for self medication is recorded and signed for. The home should ensure that the door to the laundry is closed and locked when the area is unmanned, to reduce the risk of harm to vulnerable residents Not assessed at this inspection. The registered person should ensure that staff are given the opportunity to attend regular staff meetings. Consideration should be given to offering people living at the home, the opportunity to attend their own meetings if they wish. The registered person should introduce a formal system DS0000067036.V363897.R01.S.doc Version 5.2 Page 30 2. 3. OP9 OP19 4. OP33 5. OP38 The Towans for analysing accidents so that any traits can be easily identified. The Towans DS0000067036.V363897.R01.S.doc Version 5.2 Page 31 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. 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