Inspection on 17/02/06 for Abbeyfield Connors House

This inspection was carried out on 17th February 2006.

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

Abbeyfield Connors House 24/10/06

Abbeyfield Connors House 01/08/05

Abbeyfield Connors House 19/03/05

Abbeyfield Connors House 23/06/04

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Connors House Craddock Road Canterbury Kent CT1 1YP Lead Inspector Jenny McGookin Unannounced Inspection 17th February 2006 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 Connors House DS0000023364.V282268.R01.S.doc Version 5.1 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. Connors House DS0000023364.V282268.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Connors House Address Craddock Road Canterbury Kent CT1 1YP 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) 01227 769774 01227 784290 The Abbeyfield Kent Society Mrs Jaqueline Dawn Wood Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (39), Physical disability (1) of places Connors House DS0000023364.V282268.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registration for the 1Person with a Physical Disability is limited to the person whose DOB is 21/08/1940 1st August 2005 Date of last inspection Brief Description of the Service: Connors House is registered to provide accommodation and personal care for 40 older people, twenty of whom may have dementia and one of whom may have a discrete physical disability. The Registered Provider is Abbeyfields Medway Valley Society, which is a charitable organisation, and is responsible for overseeing the operation of the Home. Mrs Wood is the Registered Manager, and is an employee of the Registered Provider. This is a predominantly single storey building, which was purpose built by Kent County Council in the 1980s. It transferred to Abbeyfield Medway Valley Society in 2000. The residents accommodation is arranged in two wings, each comprising two units, on the ground floor – Holly and Evergreen, Ash and Cedar. The Holly and Evergreen units are used principally to accommodate service users with dementia / cognitive impairment; and the Ash and Cedar units are for physically frail elderly people. Each pair of units shares a lounge/dining room, which has its own kitchenette facility, toilets, bathrooms and a suite of bedrooms. There is also a communal conservatory area and courtyard garden facilities. There are in total 32 single occupancy bedrooms, and four bedrooms which can be shared. All areas of the home are linked to a call bell system, which is designed to assist service users to summon help should it be needed. Connors House DS0000023364.V282268.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which was used to check progress with matters raised from the last inspection (August 2005,) given a number of timeframes had run their course; and to reach a preliminary view on other aspects of the day-to day running of the home. This report should, therefore, be read in conjunction with the August report. The inspection process took just over seven and a half hours, and involved meetings with three residents over lunch, and five staff. The manager and deputy manager were not on duty that day. The inspection also involved an examination of records and policy documents and the selection of one resident’s case file, to track her care. No bedrooms were inspected for compliance with the National Minimum Standards on this occasion, except in passing, where bedroom doors had been left open. The inspector checked some areas of the building, which were identified for attention at the last inspection or where refurbishment had been carried out. Interactions between staff and residents were observed throughout the day. What the service does well: What has improved since the last inspection? Some refurbishment has improved aspects of the building and there has been some progress with one or two matters raised for attention by the last inspection. Personnel records and residents’ personal files have been more systematically organised and better secured against loss and disarray. . Connors House DS0000023364.V282268.R01.S.doc Version 5.1 Page 6 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. Connors House DS0000023364.V282268.R01.S.doc Version 5.1 Page 7 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 Connors House DS0000023364.V282268.R01.S.doc Version 5.1 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4, 5, 6 1. The home has a new Service User Guide but this document does not provide Service Users and prospective Service Users with all the information they need to make a decision about moving into the home and what to expect thereon. 3, 4. Prospective residents are assessed prior to admission to establish the extent to which their needs can be met by the home, and how potential risks will be managed. Service users and their relatives are generally very content with the way they are supported by the home. 5. Prospective residents, or their representatives, have the opportunity to visit the home before proceeding with the admission and there is a trial stay to further inform their choice. 6. The home does not provide intermediate care. Connors House DS0000023364.V282268.R01.S.doc Version 5.1 Page 9 EVIDENCE: Since the last inspection, the manager has produced a new Service User Guide, which usefully describes the facilities, services and principles of care but a number of elements listed by this standard were not there. • • • • • • It needs to state whether this information is available in other languages or formats and how to access them; It needs to state the home’s admission / registration criteria in more detail – i.e. what it can/cannot cater for (e.g. nursing) It needs to include a summary of the complaints procedure, including timescales and the complainant’s option to contact the CSCI at any stage, if that is their preference It needs to summarise key terms and conditions or (as a number of providers have opted to do) include a blank copy of the contract or even advice on how to obtain this information It needs to give a selection of service users’ views of the home It needs to give contact details for the local social services and healthcare authorities The document needs to show an issue date so that the reader can judge its currency. And access to its contents would be facilitated by a contents page. Feedback on the day of this inspection confirmed feedback from the last inspection i.e. that the decision to apply to this home was influenced largely by its locality (i.e. close to where the resident or their friends or relatives had previously lived), rather than any documentary information supplied by the home. In two cases, the selection of home was actually made by close relatives, and the residents in question did not visit the home themselves, either because they trusted the judgement of their representatives or because they had already gained a positive impression of it. Both said they were satisfied with the selection made Records confirm that the home carries out a standardised preadmission assessment, underpinned by a scoring assessment process and the prospective resident or representative is invited to visit the home. Each resident is offered a four weeks’ trial stay, though the two residents who met with the inspector said that when they came in, they came into stay. On their admission, the home draws up a care plan within the first two days, which is reviewed monthly or as required, and it also carries out further assessments of the residents. The home does not provide intermediate care. Connors House DS0000023364.V282268.R01.S.doc Version 5.1 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, 11 7. The assessment and care planning processes cover a range of health and personal care needs, as well as some social care needs. Personal care is offered in a way, which generally protects residents’ privacy and dignity. 8. The home is served by a range of healthcare professionals, to promote good health and has generally adequate facilities for privacy. 9. The home has adequate arrangements for the storage and administration f medication. Residents are able to take responsibility for self-medication, and this is managed responsibly. 10. Residents confirmed that staff treat them well, and that their privacy is respected. Observed interactions between staff and residents were respectful during this inspection. 11. There is a range of policies in place to ensure that residents receive proper care when dying, and that their spiritual needs are catered for. EVIDENCE: Assessment and Care Planning Connors House DS0000023364.V282268.R01.S.doc Version 5.1 Page 11 The “Pre-Admission Assessment” covers a wide range of health and personal care and social care needs as well as the residents’ feelings about coming into a residential care home. This process is underpinned by risk assessments and is judged a holistic approach. The residents spoken to were aware there were care plans and being asked about their care needs at the outset. Less clear, however, was the extent to which residents or their relatives were involved in formal reviews, thereon, for want of records. This matter was recommended for attention at the last inspection and found to be still outstanding. Privacy and Dignity With four exceptions, all the bedrooms in this home are single occupancy, which means personal care and treatments can be given in privacy. Shared rooms have screening between the beds to afford their occupants some privacy. The inspector was advised that since the last inspection, the hand basin area has in each case been screened off to ensure their privacy. This is judged a satisfactory response. Feedback from residents confirmed feedback obtained at the last inspection, that their privacy was respected and that staff generally treated them well. The daily routines are as flexible as healthcare needs will allow. Residents confirmed that they can choose when to get up and go to bed. Healthcare The home accesses a range of healthcare professionals, but the contract states that residents would need to pay for any personal equipment / services such as chiropodists, dentists, opticians, complementary therapists and hairdressers not covered by the NHS. The resident or their representative is also liable to pay for any abnormal amounts of personal care / supervision / monitoring, and any exceptional continence requirements. The home has continued to benefit by input from undergraduate Occupational Therapists on work placements. This is judged good practice, as it enables the home to optimise its capacity to meet the needs of the residents. Medication The arrangements for medication were partially inspected at the last inspection, and this was further pursued. It was noted that one matter raised at the last inspection for attention in respect of record-keeping was found to be still outstanding. Specifically, the allergies section on MAR charts needed to be more routinely addressed. Where the dispensing chemist does not do so, staff should supply the detail. The codes for use when there are irregularities are, moreover, not as comprehensive as they could be and there was one or two examples of staff improvising. This is not ideal. Staff have access to an accredited directory on medication (BNF). Medication trolleys are properly kept locked in the medication room and access is restricted to senior staff. The Connors House DS0000023364.V282268.R01.S.doc Version 5.1 Page 12 medication room is reported to have adequate preparation work surfaces plus a sink though it has only standard taps – not elbow or wrist operated ones. This is recommended. The medication fridge temperatures are being monitored. One resident was observed self-medicating at lunch-time and confirmed information from staff, that this was supervised by staff from a discreet distance. Dying and Death Abbeyfield has a range of policies governing the care of residents as and when they die (which cover both expected and unexpected deaths) as well as support for staff and the care of their relatives, and these are supplemented by practical advice for relatives on what they should do and useful reference material. The inspector judged these policies should include the need to retain records for three years after the date of the last entry, to be complete. One of the policies properly includes the duty to notify the Commission of all deaths (regulation 37) but its reference to the Commission requires updating to take its new title into account, to avoid any confusion. Preferred funeral arrangements are established as part of the assessment or care planning processes where this is tactfully possible – the inspector noted there were gaps in the records inspected. Connors House DS0000023364.V282268.R01.S.doc Version 5.1 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 12. The residents are generally very content with their lifestyles in this home, and the home has been able to match their expectations. This home offers a range of activities inside and outside the home. 13. There are open visiting arrangements, and the home is well placed for access to local shopping outlets and the sea front activities. 14. There is choice and control over most aspects of daily routines. 15. The meals in this home are generally very satisfactory, offering both choice and variety and catering for personal preferences. Residents can also opt to eat where they eat and at different times. EVIDENCE: Social Contact and Activities The “Pre-Admission Assessment” covers social care needs (e.g. contacts, relationships, interests, hobbies, religious and cultural needs) as well as the residents’ feelings about coming into a residential care home. This process is underpinned by risk assessments and is judged a holistic approach. There were, however, some gaps in the records seen on this occasion. Connors House DS0000023364.V282268.R01.S.doc Version 5.1 Page 14 As was the case at the last inspection, the residents who met with the inspector were not able to give many examples of any particular interests and hobbies being actively promoted by the home and were more inclined to spend time on their own watching television, listening to the radio, reading etc. Feedback from staff, however, indicated a range of activities was available on and off site. Examples included dominoes, scrabble, cards, sing-along sessions, visiting entertainers, minibus rides (e.g. to the shops, sea side, garden centre). The home has continued to benefit by input from undergraduate Occupational Therapists on work placements and a gardening session was underway at the time of this visit. Cake decorating, card making and reminiscence sessions are other examples of their input. The inspector was particularly interested to see a portfolio being compiled by one member of staff in respect of one resident with special needs, which details her observations and is enhanced by photographs of events the resident was persuaded to participate in. A sensory garden has been set up to good effect and the resident is reported to have become much more interactive and confident. This is judged a very promising start, and the plan is to roll this system out to all the other residents. There is no Loop system for the hearing impaired, but the inspector was advised that a request had been submitted to Abbeyfield Kent Society (hereafter referred to as Abbeyfield) by the manager. There is a selection of Talking Books in the home’s own library, and the two residents who met with the inspector talked enthusiastically about one particular author they had enjoyed through this medium. Large print books, tapes and Braille are available from the Mobile Library. The home has open visiting arrangements, and feedback from residents confirmed this. Catering As reported at the last inspection, the chef has a hotel catering background and has been with this home for over nine years. In that time she has built up a reputation for exemplary catering and kitchen management standards, and is being used to audit and support other homes in the group. This inspection visit was used to discuss developments from the last inspection. The chef said she had been taking photographs of the dishes, which will be used as part of the residents’ therapy sessions and included in their care plans. Residents’ responses to meals are being observed and alterations made to their dished there and then. Colour coding is being used to help staff guide residents with special needs with their menu choices (e.g. salt reduction, diabetic etc) and there is reported to be improved interaction between care staff, kitchen staff and the Occupational Therapists. The inspector was also shown a folder provided by the food distribution agency Connors House DS0000023364.V282268.R01.S.doc Version 5.1 Page 15 used by this home which included lots of useful guidance, menus and ideas (finger food, buffets, themed events) to promote good nutritional intake. As reported at the last inspection, the meal sampled during this inspection was judged expertly cooked and well presented, and feedback from the residents confirmed their satisfaction with their meals – once again the catering was identified as a key strength. Residents were observed being assisted by staff in a respectful and unhurried way. See inspection report for August for more detail on the scope of this home’s catering provision. Connors House DS0000023364.V282268.R01.S.doc Version 5.1 Page 16 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 16. There is a complaints procedure readily available, and residents feel that any complaints they had would be listened to and acted on. The home relies on staff, or the residents’ families and friends to raise issues and represent the interests of the less able residents. 18. Residents feel well cared for and safe there is a policy on adult protection. Staff expressed a commitment to protect residents from abuse, but would benefit from information on the role and powers of the CSCI. EVIDENCE: The home’s complaints procedure is discreetly displayed in each bedroom, and describes the process and timeframes involved, in general compliance with the provisions of Regulation 22. It also gives the CSCI as an option at any stage, though the master copy still gives the Commission’s old title and will require updating. Feedback from residents during this inspection confirmed that they knew who to talk to if they had a complaint though this had not in practice applied. At the last inspection the home had only recently registered with a new independent advocacy service so it was judged still too early to judge the effectiveness of this. In the meantime, the home relies on staff, or the residents’ families and friends to raise issues and represent the interests of the less able residents. There is a policy on abuse and a policy on whistle-blowing, and the inspector established at the last inspection that the manager was conversant with all the Connors House DS0000023364.V282268.R01.S.doc Version 5.1 Page 17 available sources of advice and the agencies, which need to be involved and the need to take a multidisciplinary approach to strategy meetings, to ensure a timely and cohesive approach. On this occasion, staff again expressed a commitment to protect residents from abuse. Less clear once again, however, was their knowledge of the role and powers of the CSCI. This must be addressed. Connors House DS0000023364.V282268.R01.S.doc Version 5.1 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25, 26 19, 25. The layout of this home is generally suitable for its stated purpose, and residents and there are homely touches throughout. Records confirm it is being maintained and regularly inspected for safety. 20. Residents have a choice of communal areas, and furnishings tend to be domestic in character. 21. Communal lavatories and washing facilities are generally accessible to bedrooms and communal areas. None of the bedrooms has en-suite facilities. 22. There is a range of equipment and adaptations to support residents and staff in safety in their daily routines and to maximise residents’ independence. 23, 24. Most residents have access to the privacy of their own bedrooms and can personalise them with their own possessions and items of furniture. 26. The home is generally well maintained but not all areas inspected were free of any unpleasant odours. Connors House DS0000023364.V282268.R01.S.doc Version 5.1 Page 19 EVIDENCE: The layout of this home is generally suitable for its stated purpose and well maintained and decorated. However, an otherwise promising first impression was marred by a pervasive smell of incontinence in the lobby and one corridor on this occasion. Access to all area is good and there are handrails. Some matters were raised for attention at the last inspection and were found to be still outstanding, but there had been some positive and promising developments. All maintenance checks inspected were found to be up to date and in good order. Communal Facilities The home provides adequate communal space (i.e. two lounges in each unit, plus a conservatory and quiet room and dining areas) for each resident. All furnishings within the communal areas are domestic in character and of good quality, suitable for the service users needs. Most areas seen were clean, well maintained and in satisfactory decorative order, and it was noted that the corridor in the Holly Unit had been redecorated and re-carpeted as scheduled since the last inspection. The provision of more pictures was judged a homely touch. Specialist equipment and adaptation All areas are linked with a call bell system. Specialist equipment includes special mattresses, raised toilet seats, grab rails and corridor rails, and hoists. The list is not exhaustive but there were still, however, no Loop systems in the communal areas for residents using hearing aids. This was a matter raised for attention at the last inspection and found to be still outstanding but the inspector was advised that the manager had requested this from Abbeyfield. The storage of wheelchairs and walking frames appeared better managed on this occasion. Connors House DS0000023364.V282268.R01.S.doc Version 5.1 Page 20 Bedrooms There are 32 single bedrooms, which are all at least 10 square metres – none of these has en-suite facilities. There are four double rooms, each providing 20sq.m of usable floor space (i.e. in excess of the National Minimum spatial Standard), with screening between beds for privacy. However, none of the shared rooms has en-suite facilities. The inspector was advised that the sink area in double bedrooms now have screening, to afford more privacy. No bedrooms were inspected on this occasion although open doors did afford glimpses of their interiors and all appeared well maintained, personalised and in satisfactory decorative order. The inspector was advised that since the last inspection all electrical equipment brought in by residents was being tested for soundness; and that the non-provision of furniture and fitments required by the National Minimum Standard had been justified in each case by properly documented consultation or risk assessment. There has reportedly been no action taken to improved some bedrooms’ outlooks, which were judged featureless at the last inspection (lawn and fencing). The inspector would still, therefore, recommend the provision of positive focal features such as ornamentation or landscaping. The inspector was interested to see the colourful collages of pictures (which staff had assembled of icons they had identified from key working residents with dementia) used to identify bedrooms and help residents orientate around the home. This was judged a promising development. WCs and bathroom facilities There are eight communal toilets, one shower room and four communal bathrooms in the home so that residents have some degree of choice and most toilets are within easy reach of bedrooms. The inspector was shown a new walk-in shower room and an adjacent bathroom, which had been refurbished and re-configured to obtain more useable floor space and better access. The standard of workmanship in both facilities was judged of a high standard. There are no en-suite facilities in the rooms occupied by the residents. Sluice Facilities Separate sluicing facilities are provided. One facility was selected for inspection on this occasion and judged in need of redecoration, in order to maintain impermeable surfaces capable of being easily cleaned. One member of staff said she wished the home had an automated facility and that handwashing / disrobing facilities were more separate. This should be given consideration. Connors House DS0000023364.V282268.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 30 27. The numbers and deployment of staff are intended to meet the needs of residents, although the layout of the home and persisting delays in CRB clearance are testing the team’s capacity to do this. 30. The home’s training processes are designed to meet and protect the needs of the residents. Staff feel well invested in. EVIDENCE: The waking / working day at this home is from 7am till 9pm, during which time following staffing arrangements are said to apply: • 5 care staff from 7am till 2pm; and from 2pm till 9pm – comprising in each case: 3 in the dementia units (Holly and Evergreen) and 2 in the frail elderly units (Ash and Cedar). Plus a senior carer. • Mondays to Fridays: 3 general domestics plus one a senior domestic from 7am till 1pm • Weekends: 2 general domestics from 7.30am till 12.30pm • One laundry person every day from 8am till 2pm. At night time i.e. 9pm till 7am, there should be 3 care staff plus one senior carer on call for emergencies. This effectively means there is still, overall, a ratio of only one member of care staff to every eight residents during the waking day, and the layout of the units disperses them widely. At the last inspection, feedback questionnaires from most relatives/visitors indicated they felt there were sufficient staffing Connors House DS0000023364.V282268.R01.S.doc Version 5.1 Page 22 levels but peak periods (such as waking times) are said to stretch staff, particularly where two staff are required to assist individuals, and will require regular review. Recruitment documentation was not inspected on this occasion as it was found to generally compliant with the National Minimum Standards at the last inspection, and feedback from staff confirmed a systematic approach. However, delays in obtaining CRB clearance is still reported to be a problem, and staff morale is reportedly being tested by the need to cover shortfalls. On the day of this inspection visit, there was a shortfall of one care staff. Considerable progress has been made with the systematising of personnel records required to be kept by the Regulations (matter raised by the last inspection), and feedback from staff indicated a sound level of training investment in a range of health and safety related issues, although the home has still to reach its target for NVQ accreditation. Connors House DS0000023364.V282268.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 36, 37, 38 33. There are effective quality assurance and quality monitoring systems in place, based on seeking the views of key stakeholders, most notably the residents, to measure the home’s effectiveness in meeting its stated aims and objectives. 35. There are suitable accounting procedures in place to safeguard the residents’ financial interests. 36. Staff have ready access to line management and comprehensive policies on a day-to-day basis. But there needs to be one-to-one formal documented supervision in full compliance with National Minimum Standard 36, to ensure residents are in safe hands at all times. 37. Considerable progress has been made with the systematising of records, most notably personnel files and residents’ records, which have been better secured against loss or disarray. Connors House DS0000023364.V282268.R01.S.doc Version 5.1 Page 24 38. The registered manager ensures so far as is practicable the health and safety of residents and staff. EVIDENCE: The residents who met with the inspector on this occasion confirmed feedback obtained at the last inspection, that they were very satisfied with their care. Lines of Accountability There are clear lines of accountability within the home and staff continue to report that in-house line management is generally accessible. Staff have access to a comprehensive range of policies and procedures to ensure practice is compliant with expected standards. There was good evidence of Abbeyfield’s compliance with it’s duty to carry out inspection visits of its own at least once a month (Regulation 26). However, some staff still feel the registered proprietor could be more appreciative of their efforts to maintain staffing levels. Quality Assurance Residents confirmed having received satisfaction questionnaires and there was good evidence of group meetings (residents and various staff group meetings). The inspector was interested to see the latest in what appeared to be a sequence of annual “Internal Compliance Report”s (dated December 2005), carried out by a senior officer from Abbeyfield. This was judged comprehensive in its scope: examples include diversity issues, staffing documentation (recruitment, attendance, training, supervision), residents’ documentation (preadmission, on admission and post admission) as well as a range of health and safety / property maintenance matters. This list is not exhaustive. Residents’ day to day finances Most residents’ funding matters are managed by their funding authorities or families / representatives. There is no Appointeeship arrangement in the home. The inspector was shown the accounting systems being maintained for the four or five residents pocket money / allowances being managed by the home and judged them sufficiently diligent. One resident’s balance was selected at random for a check against the records and found to be accurately accounted for. Each resident has a secured cash tin in their bedroom, which they have ready access to and which senior carers have access to keys for, in the event of an emergency. If a resident runs out of money the home applies to their funding authorities or families / representatives and further cheques are reported to be readily forthcoming. Less clear, was what happened to any surplus or deficit in the end of year budgets and the manager is asked to advise on this. Connors House DS0000023364.V282268.R01.S.doc Version 5.1 Page 25 The inspector was advised that the home’s accounts are subject to periodic audits, most recently a fortnight before this inspection visit – but there was no statement of findings available for inspection on site. Staff Performance and Development There was good evidence of supervision contracts to commit staff and their line managers to performance appraisal and development. Less clear, however, was compliance in practice with the National Minimum Standard 36 i.e. one-toone formal documented supervision thereon, to ensure residents are in safe hands at all times. This matter was raised for attention at the last inspection and found to be still outstanding. Health and Safety Building maintenance records were inspected on this occasion, and found to be up to date and in good order. The home has a dedicated maintenance staff member and the inspector understands day-to-day work is logged in the House WorkBook, to ensure standards are maintained. See above for details of other auditing systems (finances and line management visits/inspections). Connors House DS0000023364.V282268.R01.S.doc Version 5.1 Page 26 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 X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 2 3 X 3 1 3 3 Connors House DS0000023364.V282268.R01.S.doc Version 5.1 Page 27 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 OP1 Regulation 5 Requirement The Service User Guide must be amended to comply with all the elements of National Minimum Standard 1, and associated Regulations. Original timescale – 31/12/05 Medication Administration Records. The allergies section needs to be routinely addressed. The following matters are raised for attention as precautions against the risk of accident: All radiators need to have guards. The plugs used to maintain the fish tank in one corridor require an external socket as they are a hazard for passing wheelchairs. Action plan / justification for non-provision to be submitted. Original timescale – 30/11/05 Bathroom in Ash Unit. Ceiling is stained. Skylight is stained and cracked. Original timescale – 30/11/05 Bedroom 1. The resident wants the wardrobe re-positioned. Original timescale – 30/11/05 Sluice areas must be maintained DS0000023364.V282268.R01.S.doc Timescale for action 28/02/06 2. 3. OP9 OP19 17 13 28/02/06 31/03/06 4. OP21 13 31/03/06 5. 6. OP24 OP26 16(2) 13(4) 31/03/06 31/03/06 Page 28 Connors House Version 5.1 7. 8. OP27 OP36 18 18(2) in good decorative order, in order to maintain impervious surfaces capable of being easily cleaned. Staffing levels must be maintained as appropriate to the assessed needs of residents There needs to be one-to-one formal documented supervision in full compliance with National Minimum Standard 36, to ensure residents are in safe hands at all times. 28/02/06 31/03/06 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 OP7 Good Practice Recommendations Care Planning reviews should routinely record who participates in each case; include the recorded views of resident and/or their representative, and any unmet needs, so that anyone authorised to inspect them can evaluate their ownership. More attention could be given to exploring each residents interests, aspirations and social needs in a practical way Policies on the death of residents should include the need to retain records for three years after the date of the last entry, to be complete. One of the policies properly includes the duty to notify the Commission of all deaths (regulation 37) but its reference to the Commission requires updating to take its new title into account, to avoid any confusion Adult Protection training should include information on the role and powers of the CSCI The installation of positive features / focal points is recommended for stretches of lawn overlooked by bedrooms to make them attractive Communal WCs. Sliding doors are recommended for transfers A Loop system is recommended for lounge areas, for residents with hearing aids, subject to assessment by DS0000023364.V282268.R01.S.doc Version 5.1 Page 29 2. OP11 3. 4. 5. 6. OP18 OP19 OP21 OP22 Connors House 7. 8. OP26 OP26 suitably qualified persons Sluice areas should have either wrist or elbow mixer taps on sinks, and diffusers over ceiling lights Some areas of the home require better continence management Connors House DS0000023364.V282268.R01.S.doc Version 5.1 Page 30 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU National Enquiry Line: 0845 015 0120 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 Connors House DS0000023364.V282268.R01.S.doc Version 5.1 Page 31 - 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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