Inspection on 14/11/07 for 87 Rectory Road

This inspection was carried out on 14th November 2007.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

87 Rectory Road 14/07/09

87 Rectory Road 07/08/08

87 Rectory Road 03/10/06

87 Rectory Road 23/03/06

87 Rectory Road 26/09/05

87 Rectory Road 31/01/05

87 Rectory Road 15/06/04

Similar services:

Chesham House

Argyll House

Dorset Lodge

Acacia House

Falcon House

Dial House Nursing Home

Cromwell Avenue (9)

Abbey Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE 87 Rectory Road 87 Rectory Road Pitsea Essex SS13 2AF Lead Inspector Mr Trevor Davey Key Unannounced Inspection 14th November 2007 11:30 X10029.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 87 Rectory Road DS0000036721.V354808.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 and Care Homes for Adults 18 – 65*. 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. 87 Rectory Road DS0000036721.V354808.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 87 Rectory Road Address 87 Rectory Road Pitsea Essex SS13 2AF 01268 583634 01268 584347 f.winn@mcch.org.uk www.mcch.co.uk MCCH Society Ltd 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) Mr Francis Anthony Winn Care Home 12 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (5), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (7) 87 Rectory Road DS0000036721.V354808.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. To accommodate the five service users under the age of 65 years who have a diagnosed mental disorder (excluding learning disability or dementia). To accommodate the seven service users over the age of 65 years, who have a diagnosed mental disorder (excluding learning disability or dementia). 3rd October 2006 Date of last inspection Brief Description of the Service: 87, Rectory Road provides accommodation, nursing care and support for twelve residents who have severe and enduring mental health illness. The home is a purpose built property with two floors and a passenger lift provides access to all floor levels. All bedrooms are single with ensuite facilities and there is a communal bathroom on both floors with a large lounge/dining room on the ground floor with a separate activities room. Residents are able to access a large garden/patio area and on-site car parking is available. The home has the use of a vehicle for transporting residents. The premises are situated in the mainly residential area of Pitsea, within close proximity of local shops and has transport links to Basildon and Southend-onSea. The current rate of fees is £1280 per week. Additional charges are made for hairdressing, chiropody, holidays, toiletries and activities. A statement of Purpose and Service User’s Guide is made available to residents. 87 Rectory Road DS0000036721.V354808.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Key Inspection site visit covered a period of 7.25 hours and covered all key standards. The registered manager, staff and residents were available during the site visit and were spoken with. Their comments and contributions received were helpful in assisting the Inspector to prepare the report. As part of the site visit, a tour of the premises took place. Personal care records and other official records within the home were inspected. The information included in the annual quality assurance assessment form (AQAA) which had been submitted to the Commission for Social Care Inspection, was also used in compiling inspection report. This form gives homes the opportunity of recording what they do well, what they could do better, what has improved as well as future plans for improving the service. The home had also conducted their own survey and quality assurance exercise and the responses received, were also used as part of the inspection process. Matters relating to the outcome of this inspection were discussed with the registered manager and assistant manager. Full opportunity was given for discussion and/or clarification both during and at the end of the site visit. What the service does well: The registered provider together with the registered manager are committed in promoting high quality care and ongoing improvements to the service. This includes a business and action plan for the home covering the period October 2007 to November 2008. Personal care records included thorough pre-admission information, which had been used to assess the needs of potential residents and how these needed to be met. The home is good at adopting a holistic approach in identifying social and emotional needs as well as using creative ways to enable individual residents to enjoy positive lifestyle experiences. Some of the residents spoke with the inspector and talked about how they enjoyed visiting the local shops and appreciated other leisure activities, which they were involved in. A good working relationship exists between the staff team and the resident group and residents are consulted and involved, wherever possible, in making their own choices regarding the level of personalised care and support required. One comment from a relative included in answer to the homes questionnaire stated, Since coming out of hospital my relative has had more opportunities to be involved in social activities and staff do a very good job indeed. 87 Rectory Road DS0000036721.V354808.R01.S.doc Version 5.2 Page 6 Overall, care plan and risk assessment information was clearly documented to reflect needs and how these should be addressed including guidance information for staff when accompanying residents and engaging in community activities. The home is also good at recognising and meeting the preferences of residents regarding the delivery of personal care and respecting individual dignity, particularly where gender issues may be a concern. Staff spoken with, enjoyed their work as well as the challenges and opportunities involved in the care and support of the residents. Positive comments were made to the Inspector as to how the staff work as a team and are supportive of one another particularly where new staff had recently been appointed. Ongoing training needs are reviewed which includes induction for new staff as well as relevant courses which help to equip the staff team to competently meet the changing needs of residents in their care. The home continues to support staff studying for the National Vocational Qualification (NVQ) Levels 2 and 3 with 50 of care staff having achieved this award. Other staff are also in the process of studying for the NVQ. Level 3. What has improved since the last inspection? As a result of listening to people who use the service, social and recreational activity is much more tailored to individual preferences to encourage more personal fulfilment. Residents spiritual needs are being met following requests for pastoral visits by local clergy which has led to a fortnightly service being held in the lounge which is well attended. Residents are now involved, with the assistance of their key worker as appropriate, in completing a questionnaire on a regular basis to explore residents’ experiences in the home. This is intended to help people to discuss any deeper emotional concerns they may have. The home has acted on the requirements set out in the last inspection report regarding health and safety issues and the management of medication. Improvements have been made to the tenancy agreement to set out more clearly for residents and/or their representatives, the fees payable, what services these cover and the arrangement for the payment of fees. 87 Rectory Road DS0000036721.V354808.R01.S.doc Version 5.2 Page 7 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. 87 Rectory Road DS0000036721.V354808.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) 87 Rectory Road DS0000036721.V354808.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 3 (standard 6 is not applicable in this home). People who use the service experience good quality outcomes in this area. Residents can expect to have their care needs assessed by the home to ensure that the proposed placement is suitable. This judgement has been made using available evidence including a visit to the service. EVIDENCE: Since the last inspection, a document has been added to the occupancy agreement/contract that has been drawn up for each resident and this was shown to the Inspector. This sets out more clearly the services and facilities residents can expect to receive from the registered provider and the 87 Rectory Road DS0000036721.V354808.R01.S.doc Version 5.2 Page 10 arrangement for the payment of fees. It also clarifies the responsibility for payment between the registered provider and the funding authorities as well as setting out other items which are the responsibility of the individual resident concerned. There have been no new admissions to the home since the last inspection but pre-admission assessment information was available for a potential resident who is shortly to be admitted. Documentation was available which had been completed by the psychiatrist setting out background information relating to hospital admission and clinical appointments. Other details were included setting out the current medication, risks and levels of motivation. The support that would be required by other health care professionals had also been recorded. Comprehensive details had also been included regarding personal care, household tasks as well as communication, religious and cultural needs. As well as an application form which which had been completed and signed by the potential resident, risk profiles together with care plans which had been drawn up by the hospital were in place. An assessment had been completed by the home regarding community skills and other information will be added to show strengths as well as needs regarding mental state and behaviour, physical health, social activities and contacts. The Pre- admission assessment process had also included several visits to the home and staff had recorded details of interaction and activities completed during these days. These procedures ensure that transitional arrangements are in place to establish suitability of the environment as well as providing opportunities for potential residents to meet other people who are already living in the home. 87 Rectory Road DS0000036721.V354808.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 People who use the service experience good quality outcomes in this area. Residents can expect to have a plan of care drawn up by the home that details all their assessed needs and the management of risk, together with the services of health care professions. This judgement has been made using available evidence including a visit to the service. 87 Rectory Road DS0000036721.V354808.R01.S.doc Version 5.2 Page 12 EVIDENCE: Personal care records for two residents were inspected and others were sampled. Information was clearly set out including personal details with photograph, records of infringement of rights as well as a condensed medical history. Information provided included fluid charts, weight records as well as medical visits and appointments. Essential medical information had also been included on a take to hospital sheet for emergency admissions. Log reports inspected evidenced health care treatment that had been provided and visits from community psychiatric nurses. Staff confirmed that they enjoyed a good professional relationship with other health care professionals. The home has introduced an additional section to the personal care records which sets out an end of life care plan following discussion with residents or their representatives. Care plans were clear to follow and had identified the goals and aims for identified needs. Good examples of care plans completed included challenging behaviour, promoting independence, healthy sleeping patterns and personal hygiene tasks. The objectives of each care plan were recorded together with the date achieved. Overall, the risk assessments had also been compiled and these clearly identified the risk and steps to be taken. Staff nurses prepare care plans and risk assessments in conjunction with support workers. Where possible residents had signed care plans and risk assessments as well as the staff member involved. One risk assessment which was inspected gave instructions for staff to provide assistance should the resident find it difficult to mobilise but specific instructions as to the type of assistance and the way this should be provided was not clear. This could lead to uncertainty for staff as to what assistance the resident requires and an inconsistency in the way it is provided. Monthly evaluations and annual reviews had been recorded. It was noted that the community psychiatric nurse had carried out reviews on behalf of the primary care trust but copies of reports setting out the outcomes of these reviews have not been sent to the home. Staff were observed to be interacting appropriately with residents in a professional and friendly manner. Residents were seen to respond well to individual members of staff as they offered support. Where personal care and assistance was needed, this was provided in a way which respected individual dignity and privacy. Residents were seen to be clean, appropriately dressed and tidy. In one of the care plans that had been inspected, this had identified where the resident had requested the assistance of female staff when receiving personal care. This had been recorded in a statement of gender care preference form. Feedback from surveys carried out by the home were positive where relatives felt that staff always tried to meet residents needs and one response received stated my sister is always clean and tidy. A card expressing appreciation of the care provided by the staff was shown to the Inspector that had been sent to the home by relatives following the death of a 87 Rectory Road DS0000036721.V354808.R01.S.doc Version 5.2 Page 13 resident. In their AQAA self-assessment form, the home states that they have managed residents with serious illnesses at the home and enjoy strong collaborative links with primary health care providers and specialist agencies such as Macmillan Nursing. A check was made of the medication administrative arrangements in the home. The medidose system is used and photographs of residents were displayed on each blister pack to clearly identify residents. Overall, medication administrative records were completed in accordance with agreed procedures. In one of the samples inspected, transcribing had taken place on the medication administrative records (M.A.R.) sheets but two staff signatures had not supported this. The senior house officer from the hospital visits the home and is able to change medication as required. A letter to the local doctor confirms these changes with a copy being sent to the home. Sometimes, however, it is understood that it can take two to three weeks before this confirmation is received by the home. Arrangements should be made to minimise these delays and to ensure that confirmation is provided at the time when medication is changed. The home has stated in their AQAA selfassessment form, that arrangements are being made within the next 12 months for accredited in-house training to ensure best practice standards relating to medication procedures. 87 Rectory Road DS0000036721.V354808.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service Users have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 People who use the service experience excellent quality outcomes in this area. Residents can expect to receive a balanced diet and assisted in maintaining family/friend/community contact. Residents can always be assured of a meaningful activities/recreational programme that meets their needs and interests. This judgement has been made using available evidence including a visit to the service. 87 Rectory Road DS0000036721.V354808.R01.S.doc Version 5.2 Page 15 EVIDENCE: Records available showed the meals which had been chosen by residents and prepared for them on an individual basis. Residents spoken with had positive comments to make about the standard and variety of meals provided. They particularly enjoyed Chinese meals and fish and chips. Staff spoken with, confirmed that they had done food hygiene training. The environmental health officer had visited in March 2007 and no issues regarding food preparation, storage or hygiene were raised as concerns. Records were available showing cooked meat temperatures as well as fridge and freezer temperatures that had been completed on a regular basis. One of the members of the staff team has specific responsibility for arranging a suitable programme of social and recreational activities which take into account individual as well as group interests. This member of staff explained to the Inspector that they meet with residents as a group each month and records were available of these meetings. In addition, they meet with individual residents to find out their preferences and individual choices. Particular visits and outings are arranged to encourage residents to pursue their hobbies or interests. These include visits to aquariums, local clubs and leisure centres as well as enjoying meeting their friends for meals. Music therapy takes place in the home each week for those residents who wish to join in and according to the AQAA self-assessment form completed, this has helped group cohesion and development. Following a request by residents, local church services are held fortnightly in the home. For residents who wish to go on holiday, these are arranged in line with personal preferences. These included an extended family reunion in Wales, retracing World War II experiences and a tour of the Lake District. One of the residents spoken with said how she had enjoyed visiting the local town that morning and showed the Inspector a new suit, which she had purchased. She also spoke about the recent party she had enjoyed where she was able to meet up with a number of her friends. Other positive comments were made by residents saying how they liked to go out with staff who accompany them. The personal care records also included community risk assessments which involved the use of transport, safe wheelchair procedures and the number of staff required. The Inspector was advised by the member of staff currently taking on the activity organiser’s role, that letters had been sent out to relatives and other care homes to give opportunities for residents and families to meet together on a social basis. Staff were observed to be communicating effectively with residents but where necessary, books with symbols are used to increase understanding. An activities folder is kept which shows a timetable for social and recreational activities each week. A record is made of individual activities and interests that residents take part in. Other residents showed the Inspector photographs that had been sent to them as well as drawings and paintings they had completed. 87 Rectory Road DS0000036721.V354808.R01.S.doc Version 5.2 Page 16 Residents tend to meet and spend their time in the lounge /dining area, a large room which can become noisy at times. The home has plans for creating other quiet areas which residents can use if they so wish. A small activities/games room is used sometimes by residents who prefer to be away from the main group. 87 Rectory Road DS0000036721.V354808.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use the service experience good quality outcomes in this area. Residents can expect to have their complaints taken seriously and be assured that they will be protected by the home’s safeguarding adults from harm procedures. This judgement has been made using available evidence including a visit to the service. EVIDENCE: No complaints had been recorded since the last inspection. The complaints procedure is set out in the Service User’s Guide. In the completed AQAA selfassessment form, the home acknowledges that they need to refresh and updated the complaints procedure to make it more assessable to residents and their families. Policies and procedures on safeguarding adults from harm were in place and all staff have received training on the reporting procedures which is updated annually. The manager was not aware of any outstanding safeguarding matters. Staff spoken with, were aware of the reporting procedures to be used should any safeguarding issues arise. 87 Rectory Road DS0000036721.V354808.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20 and 26 People who use the service experience adequate quality outcomes in this area. Residents can expect to live in a clean and comfortable environment. This judgement has been made using available evidence including a visit to the service. 87 Rectory Road DS0000036721.V354808.R01.S.doc Version 5.2 Page 19 EVIDENCE: Residents live in a homely environment which is clean and hygienic. Ongoing maintenance and servicing of equipment takes place. Since the last inspection, health and safety issues which were of concern regarding the laundry and sluice areas have been addressed. Potentially hazardous areas in the kitchen, laundry room and sluice are now locked when staff are not present. According to the completed AQAA self-assessment form, staff have been retrained in safe custody of hazardous materials in accordance with the regulations for control of substances hazardous to health (COSHH). During the site visit, it was noted that the storage cupboard for hazardous materials was securely locked. Staff are trained in infection control procedures and one of the staff nurses has been approved as the lead nurse for infection control procedures in the home. An annual check has also made of infection control measures in the home by the hospital. Reference has already been made in this report to the need for creating an alternative quiet communal area for the use of residents. One of the members of staff spoken with, recognised the drawbacks of one communal room and that there is a tendency for some of the residents to dominate conversation and to become confrontational. An alternative quiet room would help to defuse situations and offer residents an alternative area in the home which could be used for communal purposes. A designated area must also be provided for residents in the home who wish to smoke. New armchairs and a television have been provided in the main lounge. The home in their AQAA selfassessment form, refer to plans to redecorate the premises taking into account residents’ choices and preferences. This will include improved signage of toilets and bathrooms for residents and their visitors. 87 Rectory Road DS0000036721.V354808.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 People who use the service experience good quality outcomes in this area. Residents can expect to be cared for by suitable numbers of staff on each shift which meets their needs. Residents can be assured that records will be able to demonstrate that the home has followed robust recruitment and employment procedures. This judgement has been made using available evidence including a visit to the service. EVIDENCE: Staff rotas were available and the normal provision of staff allows for one qualified registered mental nurse and four support workers to be available for the early shift with one qualified nurse and three support workers for the late shift. Two support workers are available between 6 p.m. and 8:30 p.m. when 87 Rectory Road DS0000036721.V354808.R01.S.doc Version 5.2 Page 21 the night staff come on duty which consists of one qualified nurse and support worker. In addition, the manager and/or deputy are available on a supernumerary basis. Other staff include an activities organiser from 9 a.m. till 4:30 p.m. and a cook and domestic worker who are employed for five hours per day (Monday to Friday). It is recommended that staffing levels be reviewed to enable a cook to be provided for weekends as other members of the care staff are having to cover these duties at present. This could detract from the care and support that would otherwise be made available to residents. Arrangements have been made with the registered provider and the provider relationship manager of the Commission for Social Care Inspection, for recruitment records to be checked at the central office in Maidstone every six months. The registered provider notifies the home once recruitment checks have been completed for new members of staff including Criminal Record Bureau (CRB) procedures. Two new staff had recently been appointed. Written confirmation was available to show that the registered provider had carried out recruitment checks, including C.R.B procedures. The home also keeps a checklist of recruitment records completed. Application forms are seen by the manager which are then sent to central office. References are also sent to the home by Central office for the manager to see which are then returned. Evidence of identification was available in the home for staff recently appointed. In the AQAA self-assessment form, the home feel they could do better by giving residents the opportunity of being included in the recruitment and selection process. Records were available of training completed by staff including induction, which included moving and handling and adult protection awareness. Staff induction is based on the Skills for Care model and staff are provided with workbooks as part of the assessment process. New staff spoken with confirmed that they were undertaking induction training plus other courses such as procedures for control of substances hazardous to health. At the time of inspection, ten staff had completed National Vocational Qualification (NVQ) Levels 2 and/or 3 and one of the staff nurses is a N.V.Q. Assessor. In addition, there are five qualified Registered Mental health nurses on the team. Staff spoken with said how they enjoyed working in the home and that their colleagues work as a team which they found to be very supportive. Staff confirmed that meetings take place and the management, together with the registered nurses, also meet as a group by themselves occasionally. Positive comments from relatives about how they felt supported by the staff were included in the feedback from questionnaires returned to the home. These included staff are always helpful and happy, staff are very welcoming and how staff consults them about care issues. 87 Rectory Road DS0000036721.V354808.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 People who use the service experience adequate quality outcomes in this area. 87 Rectory Road DS0000036721.V354808.R01.S.doc Version 5.2 Page 23 Residents can expect to live and be supported in a home where the management and administration of the service is good but issues relating to safety in the home have not all been addressed. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The manager has considerable experience and is qualified as a Registered Mental Nurse. Good communication systems are in place involving senior management and the staff team. Regular staff supervision takes place from which training needs identified and staff are encouraged to enrol for courses as part of their ongoing staff development. Monthly monitoring visits take place on behalf of the registered provider and reports of these visits are sent to the Commission. The home has demonstrated its willingness to listen to residents and involve them and relatives in ongoing quality assurance surveys. It is recommended that other health care professionals’ views are also obtained to contribute to the quality monitoring exercise. Most of the residents take part and are co-operative in providing information for these surveys but because of complex mental health problems, the feedback received, can vary from day to day. The home produced a business plan in October 2007, which sets out targets to be achieved together with dates and outcomes expected up until November 2008. This plan includes reassessment of residents needs to identify whether the placement in the home is suitable or whether other options are preferable. Other topics included are the training of staff, patterns of working and residents’ surveys. Reference is also made to show how the registered provider intends to develop the home in the future. This demonstrates that the home is prepared to analyse and look at the existing service to residents as well as looking at how these can be improved in the future. A sample of records were inspected which showed regular servicing and maintenance had taken place of hoists, the lift and other equipment. The gas safety certificate expired in July 2007 and one of the three gas boilers which had been unsafe, has being taken out of use. A new gas safety certificate is still awaited and it is understood that this will not be issued until the faulty boiler has been replaced. This issue has been repeatedly brought to the attention of the registered provider by the manager on at least eleven occasions and recorded in the home’s maintenance record book. The Inspector was advised by staff that some of the bedrooms are getting cold. The registered provider has a responsibility to give this matter urgent attention to ensure the premises are maintained at suitable temperatures at all times by a safely maintained heating system. Risk assessments for a safe working 87 Rectory Road DS0000036721.V354808.R01.S.doc Version 5.2 Page 24 environment are in place but these should be reviewed annually or sooner if required. A fire risk assessment had been carried out and the fire officer has advised that smoke detectors should be fitted in the sluice room, cupboards and storage areas. It is understood that the registered provider is in the process of arranging for these smoke detectors to be installed. Records were available showing that fire extinguishers had been serviced and fire drills carried out. Fire alarms are tested weekly. Records were available of hot water temperature checks that are completed on a two weekly basis. A sample check was made of personal allowances and records of transactions were properly documented including two staff signatures and copies of receipts. The assistant manager checks the balances of money held by the home on behalf of residents daily. The registered provider arranges for these accounts to be audited annually. 87 Rectory Road DS0000036721.V354808.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 x 2 3 3 4 4 x 5 x 6 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 4 13 4 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 x ENVIRONMENT Standard No Score 19 3 20 2 21 x 22 x 23 x 24 x 25 x 26 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No Score 31 3 32 x 33 3 34 x 35 3 36 x 37 x 38 2 87 Rectory Road DS0000036721.V354808.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP20 Regulation 23(2) Requirement An alternative suitable quiet communal area must be created which residents can use. This is to ensure that residents have an alternative area for pursuing quieter activities and small group conversation. The previous timescales of 31/03/06 and 30/11/06 have not been achieved. 2. OP20 23(2) A suitable designated smoking area must be provided in the care home, which residents can use. This is to ensure that residents can exercise their right to smoke without affecting the health and comfort of others. 3. OP38 13(3)(4) 23(2) Suitable temperature levels for the heating must be provided to meet residents’ needs at all times. An up-to-date gas safety certificate must be obtained. This is to ensure that residents 87 Rectory Road DS0000036721.V354808.R01.S.doc Version 5.2 Page 27 Timescale for action 31/03/08 31/03/08 31/01/08 are comfortable in the building and the heating system is safe to use. 4. OP38 23(4) Adequate fire prevention measures must be installed on the premises in accordance with the advice given by the fire officer, including additional smoke detectors where required. This is to ensure residents and staff are able to be fully alerted against the risk of fire. 15/01/08 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 OP8 Good Practice Recommendations Copies of reports relating to reviews carried out by the Primary Care Trust should be given to the home. This provides confirmation of the decisions and outcomes agreed for residents. Confirmation of changes to medication should be given to the home more promptly. This minimises the risk of errors occurring in the administration of medication. An additional cook should be appointed to cover weekends. This is to ensure that care staff are available to give priority to the care and support of residents. Surveys carried out by the home of the service provided, should include the views of health care professionals. This is to ensure that all people connected with the service are able to contribute to the quality assurance assessment of the home. 2. 3. 4. OP9 OP27 OP33 87 Rectory Road DS0000036721.V354808.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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. 87 Rectory Road DS0000036721.V354808.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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