Inspection on 06/12/06 for Abbotsford Nursing Home

This inspection was carried out on 6th December 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Abbotsford Nursing Home 04/12/08

Abbotsford Nursing Home 21/12/05

Abbotsford Nursing Home 18/08/05

Abbotsford Nursing Home 12/05/04

Abbotsford Nursing Home 30/12/03

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Abbotsford Nursing Home 21 Gilbert Road Romford Essex RM1 3BX Lead Inspector Julie Legg Key Unannounced Inspection 10:00 6 – 14th December 2006 th 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 DS0000034878.V321707.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. DS0000034878.V321707.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Abbotsford Nursing Home Address 21 Gilbert Road Romford Essex RM1 3BX 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) 01708 740355 Mrs Carmel Elizabeth Dempsey Indira Sandhu Care Home 18 Category(ies) of Dementia - over 65 years of age (3), Old age, registration, with number not falling within any other category (15) of places DS0000034878.V321707.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st December 2005 Brief Description of the Service: Abbotsford is a privately owned nursing home and is registered to provide accommodation and nursing care to eighteen older people. Most of the residents have moderate to high needs due to their physical frailty or dementia. The home is situated in a quiet residential area of Romford and is close to the local shopping centre. The home is well served by public transport; both buses and the main line train station are within walking distance. The home is wheelchair accessible and a passenger lift is installed. There are two single bedrooms and eight double bedrooms; none of these rooms are en-suite. The home has a large back garden and there is off street parking at the front of the house. The statement of purpose and the service user guide are issued to every prospective resident and both of these documents are displayed on the residents’ notice board, which is situated in the hallway. A copy of the most recent inspection report is also displayed on this notice board. A relative/ representative could ask for his/her own copy, which the manager would make available. The fees for the home are £535 - £650 a week according to the person’s needs. The administrator made this information available on 6th December 2006. DS0000034878.V321707.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection took place over one day and lasted eight hours. The inspector spoke to a number of residents about their experience of moving into and living at Abbotsford and to seven relatives, who were visiting the home on the day of the inspection. Discussions took place with the proprietor, the manager, senior carer; four care staff, the chef and the activities co-ordinator. Staff were spoken to about care practices and their employment at the home. Staff were observed directly and indirectly providing care to residents. A health professional that visits the home was also contacted for their views of the care given. A tour of the home was undertaken and a number of staff and residents’ files as well as other records were examined. As part of this unannounced inspection the quality of information given to people about the care home was looked at. People who use services were also spoken to, to see if they could understand this information included the service user guide (sometimes called a brochure or prospectus), statement of terms and conditions (also known as contracts of care) and the complaints procedure. These findings will be used as part of a wider study that CSCI are carrying out about the information that people get about care homes for older people. This report will be published in May 2007. F urther information can be found on our website www.csci.org.uk. What the service does well: Abbotsford provides the residents with a very homely environment and a welcoming atmosphere for visitors. On the day of the inspection there was a continuous stream of visitors, all commented that they were made to feel very welcome and enjoyed visiting the home. There was a warm relationship between the staff and the visitors, many of whom visit at least once a week and others 2-3 times a week, one relative visits every day and has his lunch provided by the home. Residents stated “the staff are lovely”, “I like living here and they look after me”. Relatives commented “they treat her like a queen”, “I couldn’t ask for better care for my mum”, “I visit at all different times and he is always looking smart, which use to be very important to my dad”. The home has good staff retention, which means that residents do not continually have to get use to new faces. This has an impact on the care given to the residents, as staff are very aware of the residents’ needs and how these DS0000034878.V321707.R01.S.doc Version 5.2 Page 6 should be met. Staff were observed to offer assistance in a way that respected each individual resident. Their relationship with the residents was warm but professional. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by DS0000034878.V321707.R01.S.doc Version 5.2 Page 7 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. DS0000034878.V321707.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000034878.V321707.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2, 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents and their relatives/representatives have sufficient information they need to make an informed choice. Every resident has a copy of the home’s contract/statement of terms and conditions, setting out the responsibilities of both parties. A pre-admission assessment is undertaken for all prospective residents, this will ensure that their identified needs can be appropriately met by the home. EVIDENCE: The Statement of Purpose has been revised and further developed and every resident has been issued with a copy. The Service User Guide is informative and written in plain English, it contains a summary of the Statement of DS0000034878.V321707.R01.S.doc Version 5.2 Page 10 Purpose, the terms and conditions in respect of accommodation, a copy of this document has also been given to residents. Four residents were shown a copy of the Service User Guide and asked, “have you seen this leaflet before and do you have a copy”? Two of the residents were unable to confirm whether they had received a copy of the Service User Guide, however the other two residents (one resident had recently moved into the home) said that they had received a copy prior to moving into the home. One resident said that she had found it useful but the other resident stated, “that she was not sure if he really understood it”. Three relatives were also asked “have you seen a copy of this leaflet before”? All three relatives stated that they had seen it and a copy had been given to them and their relatives. One relative stated “I found it useful but my Mum didn’t understand it”. Many of the residents have either dementia or a cognitive impairment; therefore it is essential that information be given to them in a pictorial format, which would be easier for the residents to understand. This is Requirement 1. Four files were inspected and there was evidence on all files as to the charges for their cost of care, all of which were funded by their local authority. There were copies of letters that had been sent to the residents and relatives regarding fee increases and each prospective resident is given a pre-pared pack that contains the Service User Guide, the Home’s complaints procedure, Statement of Purpose and some details of the home and the composition of all the staff employed at the home. The above residents and relatives were also asked “were you given verbal or written information on the fees of the home”. None of the residents could answer the question but all three relatives stated that they were advised of the original fees and subsequent increases in writing. Files that were inspected all had copies of the contract that was signed by the resident/relative, the home and the funding authority; there was also a copy of Abbotsford’s Terms and Conditions. Every file stated that the resident/relative had received a copy of both of these documents. Four residents were spoken to and shown a copy of the Terms and Conditions, two of the residents were unable to confirm whether they had received a copy, however the other two residents confirmed that they had received a copy. None of the residents knew whether there had been a change in the Terms and Conditions. Three relatives confirmed that they had received a copy of the Terms and Conditions and had been notified in writing of subsequent changes. All of the files examined showed a copy of a needs led assessment, the majority of the residents are funded by their local authority and their assessment had been carried out by a social worker. However the manager of Abbotsford visits every prospective resident and carries out her own assessment as well, this ensures that the home is able to meet the prospective residents’ needs. Four residents were spoken to and asked “Did anyone talk to you about what difficulties you have and what assistance you need. Two of the residents could not remember if anyone had visited them, however the other DS0000034878.V321707.R01.S.doc Version 5.2 Page 11 two residents were able to confirm that they had been visited by a lady who asked them questions, one resident did not know whether she was a social worker or not and that they both could remember being visited by Indira (the manager) before they came to live at Abbotsford. Three relatives confirmed that social services and Indira had assessed their relatives prior to their admission to the home. The home does not provide intermediate care. DS0000034878.V321707.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 and 11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents health, personal and social care needs are set out in individual care plans and provide staff with the information they need to satisfactorily identify and meet residents’ needs. There are clear medication policies and procedures fro staff to follow and medication records are being completed correctly, which safeguards the residents with regard to the administration of their medication. Residents are treated with respect and the arrangements for their personal care ensures that their right to privacy is upheld. Residents’ wishes in relation to their funeral arrangements are identified on their care plans but they do not have end of life care plans. However this matter is being dealt with, which will ensure that residents’ wishes in relation to death and dying are clearly identified. DS0000034878.V321707.R01.S.doc Version 5.2 Page 13 EVIDENCE: Individual care plans were available for each of the residents. The records of four residents were examined and five residents and seven relatives gave their views. Considerable work has taken place in ensuring that the care plans truly reflect all of the residents’ needs and that these needs are being met. The care plans are now detailed and comprehensive, identifying the residents’ personal, social, cultural, religious and health needs and how these needs should be met. Staff spoken to were able to demonstrate that they fully understood their role in completing and updating the residents’ care plans as the need arises. Four care plans were examined and there was evidence that all care plans are being evaluated and updated monthly and are reflecting residents’ changing needs. Residents’ health needs are clearly identified as part of their overall care plan and how these needs should be met. Records indicate that health professionals including opticians, dentists, chiropodists, GP and the Tissue Viability Nurse have seen the residents. Other written evidence includes residents being weighed monthly, nutritional and fluid intake. The inspector contacted a health professional who visits the home and stated “ I am satisfied with the care at Abbotsford, the manager will always air on the side of caution and will contact me with any concerns”. Four risk assessments were examined and there was evidence that these risk assessments are being reviewed monthly or when a change in risk is identified. The risk assessments are fairly detailed and cover areas such as moving and handling, bathing, breakdown of pressure areas, use of cot sides, continence and falls. Residents were possible and relatives have been consulted in formulating these assessments. One relative that was spoken to stated “My mum had 29 falls in the previous home and she hasn’t had one since she has been here”. There are policies and procedures for the administration and recording of medication, guidance on homely remedies and an error in administration of medication policy. Medication Administration Records (Mar) were examined and all had been completed appropriately and medication given correlated with the MAR charts. The inspector spoke to a number of residents and relatives who all said that staff were respectful and thoughtful when attending to personal care. One relative said “They treat my mum like I would, the staff are wonderful”, another relative said “I leave here and don’t have a minutes worry, my dad is looked after so well”. One resident said, “The girls are marvellous, they are kind and respectful”, another resident said, “I don’t always remember but they DS0000034878.V321707.R01.S.doc Version 5.2 Page 14 never get cross with me, they are really patient”. Staff talked about and were observed to treat residents in a respectful and sensitive manner. They understood the need to promote dignity through practices such as in the way addressed residents and when entering bathrooms and bedrooms. On examining residents’ files their wishes are recorded but these wishes are more appertaining to whether they would want to be cremated or buried and who to contact. ‘End of life’ care plans should be more detailed than this and include the care they would like and where they want to be cared for at the end of their life and what they do not want to happen. The manager has this matter in hand and has arranged for Ian McQuarrie (End of Life Care Programme Manager) to come and speak to her and the staff to ensure that residents’ wishes are recorded appropriately. DS0000034878.V321707.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is an activities programme that provides variation and interest for people living at the home. Visiting times are flexible and visitors are made to feel welcome, this ensures that residents are able to maintain contact with friends and relatives. Residents are assisted to exercise choice and control over their lives. The meals in the home are well presented and nutritionally balanced. They offer both choice and variety to the residents. EVIDENCE: Since the last inspection the home has employed an activities co-ordinator. She has been in post for four months and works 9-4 Monday- Friday. She has already attended some training covering areas such as; nutrition in older DS0000034878.V321707.R01.S.doc Version 5.2 Page 16 people, ‘meaningful activities in dementia care’, NAPA activity programme and managing challenging behaviour. There has already been a marked improvement in the activities that are offered both individually and in groups. The activities co-ordinator has commenced ‘life story books’ for the residents and has enlisted the assistance of friends and relatives to gain information on residents backgrounds, including family history, previous hobbies, likes and dislikes, beliefs and special memories and stories as well as photographs. Most of the residents have been registered to use dial-a-ride, which some residents have taken advantage of. In the mornings she tends to work with residents individually, sitting and chatting, going to the shops, going to the park to feed the ducks and going out for lunch. In the afternoons she works in small groups with activities such as, knitting, quizzes, sing- a-longs, reminiscence sessions and currently some of the residents are making Christmas cards. Music for health workshops take place every other week and every month there is a musical entertainer, Other activities that have taken place or arranged include; a garden party in the summer, which was very successful, a trip to a Christmas pantomime and a Christmas party are to take place and some of the residents are going Christmas shopping. Residents have attended the Harvest festival at a local school and have also been invited to their carol service. A number of residents and relatives took part in the ‘Memory Lane Walk’ on behalf of the Alzheimer’s Society, every participant was presented with a certificate and these are placed in the hallway with photographs of the event. Residents and relatives were pleased with the increase in activities, one resident said ”I was reluctant to go out at first and just went round the block, now I go and feed the ducks at the park. I really enjoy it”, another resident said, “I have been out to lunch with Vivien (activities co-ordinator), it was lovely”. Activities are now more person centred and take into account individual choices. This was a previous Requirement that is now met. Residents’ care plans indicate their preferred name, their choice as to when and where they take their meals, whether they choose to have a bath or shower, where they would like to receive their visitors and their wishes regarding their death. The home carried out a residents and relatives’ survey earlier this year, the main aims of the survey were to find out the level of satisfaction on the services provided, were residents’ choices/rights being observed and if the homes aims and objectives were being met. The home has developed a plan in response to the survey and areas have been identified that the residents are wanting the home to improve on. One of these areas has already been dealt with, which is the employment of an activities co-ordinator; this has increased the quantity and quality of the activities. Visiting times within the home are very flexible and this was evident during the inspection, as there was a continual flow of visitors during the day. On looking at the visitor’s book it was evident that there are visitors to the home every day and on the day of the inspection, the inspector spoke to seven relatives. One relative who visits daily has his lunch provided and other visitors commented “We are always offered tea/coffee and biscuits” and other DS0000034878.V321707.R01.S.doc Version 5.2 Page 17 comments were, “We are always made to feel very welcome”, “We can visit at any time” and “We feel like one big family here”. Meals are served in the lounge/dining room, there are no separate dining room tables and residents have their meals sitting in their armchairs with individual tables in front of them. On the day of the inspection, the meals were seen to be balanced in nutrition and generous portions. The main meal was chicken, cabbage, carrots and mashed potatoes all of the vegetables were fresh; one of the residents had peas as she told the inspector that “I don’t like cabbage”. The alternative meal was meatballs. The chef is fairly new to the home; he has an extensive catering background, which included cooking meals for people with medical conditions and from different cultures. The chef stated that he would prepare something different if either of the choices were not to a residents liking. No cultural diets are catered for but one of the residents is diabetic and six of the residents’ meals have to be pureed. New plates with sections have been purchased so that the food when pureed is still separate, which ensures that each portion of food is not running into each other. Specialised cutlery has also been purchased; this will assist residents to eat independently who have difficulty in holding an ordinary knife and fork. One of the residents has difficulty in sitting with other residents whilst eating, she now takes her meals in a smaller room accompanied by a member of staff, which has eased her distress. Residents and relatives spoke highly of the food, one relative who has his lunch at the home said, “The food is as good as any restaurant I have eaten in”. Many of the residents require assistance with eating their meal and staff were seen to carry out this task appropriately, talking to residents and not rushing them. A few of the residents lost interest in their food and again staff acted appropriately offering words of encouragement to eat. DS0000034878.V321707.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints procedure in place and residents and relatives feel confident that their complaints and concerns are listened to and acted upon. The home has a satisfactory policy and procedure regarding allegations of abuse. The staff have undertaken training in adult protection/abuse awareness to ensure that there is an appropriate response to any allegations of abuse. EVIDENCE: The home has a written complaints policy and procedure and the complaints book was examined during the inspection. There was only one complaint since the last inspection and the manager has dealt with this appropriately and to the satisfaction of the complainant. Five residents were asked, “If you were unhappy about anything in the home, who would you talk to?” all five said they would talk to Indira (manager). All of the relatives that were spoken to said they would talk to the manager if they had any concerns and felt confident that they would be listened to. There is a written policy and procedure for dealing with allegations of abuse and whistleblowing. The home also has copies of the local authority (Havering) DS0000034878.V321707.R01.S.doc Version 5.2 Page 19 documentation on adult abuse. There is an ongoing training programme, which includes administrative and ancillary staff on adult protection/abuse awareness. Staff that were spoken to confirmed they had attended training and were aware of the action to be taken if there were any concerns about the safety and welfare of the residents. DS0000034878.V321707.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is very welcoming and provides the residents with a clean, safe and comfortable environment in which to live. However the kitchen cupboards require some attention to ensure the facilities do not provide a health and safety risk to staff and residents. There are sufficient, suitable toilets and bathrooms for the number of residents. Specialist equipment such as hoists, mattresses and walking aids are available to meet the needs of the residents. Residents’ bedrooms suit their needs. DS0000034878.V321707.R01.S.doc Version 5.2 Page 21 EVIDENCE: The home has a very welcoming and homely atmosphere. A tour of the home was undertaken, which looked very festive indoors and out with Christmas decorations adorning the living room and some of the residents’ bedrooms (this was their choice), as well as lights on the outside of the home. The home has an ongoing redecoration and refurbishment programme. Since the last inspection new carpets have been fitted in the living room, the downstairs and upstairs hallways as well as new floor covering in the visitors’ and chef’s toilet. The home has been painted throughout and new curtains have been hung in residents’ bedrooms. A new fridge/freezer and tumble dryer have also been purchased. The living area of the home consists of a large living/dining room this room is appropriately furnished and is homely in its appearance. The laundry room and food store cupboard were found to be clean and tidy and free from clutter. The kitchen requires a new sink and would benefit from a refit as the work surfaces and cupboards are worn and chipped. This is Requirement 2. All of the residents’ bedrooms are appropriately furnished and found to be very clean and free from any odours. All of the bedrooms were personalised; with items of furniture from their own homes, many had their own televisions, radios and lots of photographs, pictures and ornaments. Some of the bedrooms have electrically operated beds and hoists, which ensure the safety and comfort of the residents. All communal washing and bathing facilities were in working order, clean and odour free. The home is cleaned on a daily basis and throughout the inspection the home was found to be clean, tidy and free from any offensive odour. Residents and relatives indicated that they were very satisfied with the standards of hygiene and cleanliness within the home. DS0000034878.V321707.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s staffing levels are good and there are sufficient staff on duty, who have the skills and training to meet the individual needs of the residents. The home has a clear recruitment policy and procedures and appropriate checks are undertaken, which ensures the protection of the residents. EVIDENCE: Staff rotas were examined and the rota correlated with the number of staff on duty on the day of the inspection. During the day there are three care staff and an RGN and at night one RGN and one care staff, which is sufficient to meet the needs of the residents. In addition during the day there is an activities coordinator and sufficient cleaning and catering staff. Since the last inspection staff files showed that staff have undergone further training in fire safety, fire warden course, NAPA activity programme, ‘yesterday, today and tomorrow’, meaningful activities in dementia care and managing challenging behaviour courses were provided by the Alzheimer’s Society. Moving and handling, first aid and adult protection were also undertaken. All care staff attend weekly training sessions, which encompasses DS0000034878.V321707.R01.S.doc Version 5.2 Page 23 the Skills for Care Common Induction Standards, this is in preparation for the commencement of staff undertaking NVQ 2 training and as a refresher course for those staff that have already attained their NVQ 2/3. Staff that were spoken to all stated that they very much enjoyed working at the home, that they had received appropriate training and felt supported by the manager and the senior carer. A face-to-face interview takes place with all candidates; the interviewing panel normally consists of the manager (RGN) and the senior carer. Staff files that were examined showed that all relevant recruitment checks had been undertaken. All files had two written references, Criminal records bureau (CRB) checks, copies of work permit (authority to work), copy of passport, birth certificate and utility bill were all on file as well as a recent photograph. Staff files indicated that all new staff undertakes an induction programme, which includes health and safety aspects of the home, policies and procedures, privacy and dignity of older people and code of conduct. Newly recruited staff confirmed to the inspector that they had undertaken an induction programme. DS0000034878.V321707.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,37 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents live in a home that is run in their best interests by a manager who is a qualified nurse and has previous managerial experience in a residential care setting. However a management qualification i.e. The Registered Manager’s Award needs to be undertaken. Staff rotas that were examined indicated that the manager is rotered as the nurse on duty, on all of her shifts. The manager requires dedicated time to enable her to carry out her managerial tasks outside of giving direct patient care. The home’s record keeping, policies and procedures safeguard residents’ financial interests and rights. Staff receive regular and appropriate supervision. DS0000034878.V321707.R01.S.doc Version 5.2 Page 25 Residents and staffs’ health, safety and welfare are promoted and protected. EVIDENCE: The manager is a registered nurse and has the relevant clinical qualifications, she has the experience in providing and managing care services but needs to undertake a management qualification i.e. Registered Manager’s Award. This is Requirement 3. She has an understanding of the needs of the residents and the areas in which the home needs to improve and further develop. Residents and relatives commented that she is approachable and helpful. The registered proprietor also spends a considerable amount of time at the home, and is very involved with the running of the home. Comments from staff indicated they appreciated the proprietor having a high profile within the home and commented on her open and friendly approach. The home has developed an annual development plan, which reflects the aims and outcomes for the residents. This plan comes from the result of the homes quality assurance survey, which residents and relatives completed. Residents and relatives meetings are also sought at regular meetings and acted upon. Staff rotas that were examined indicated that the manager is rotered as the nurse on duty, on all of her shifts. This is not acceptable as the manager Requires dedicated time to enable her to carry out tasks, such as the auditing of care plans, risk assessments, staff supervision, the development of the service and any other managerial tasks. This is Requirement 4. Monthly visits are carried out by the registered proprietor under the requirements of Regulation 26 of the Care Homes Regulations and reports of these visits are submitted to the Commission. These reports are informative and comprehensive. Significent events are also reported to the commission. The home has an appropriate policy and procedures regarding safeguarding residents’ finances. Currently the home are not responsible for any residents, this task is carried out by relatives/friends. The home keeps small amounts of cash for residents’ day-to-day requirements, four residents’ monies were checked against their balance sheets and all were correct. DS0000034878.V321707.R01.S.doc Version 5.2 Page 26 Staff meetings are taking place quarterly and are following the residents’ meetings; this enables information from the residents’ meetings to be feedback to the staff meeting within a week. Staff files were examined and discussions took place with care staff and the manager. All staff have been issued with a supervision contract that has been signed by both parties and regular supervision is taking place. All staff have also received an annual appraisal. This was a previous requirement that is now met. It is a Recommendation that the senior carer and the manager attend a supervisor’s course. This is Recommendation 1. Systems are in place for the regular auditing and monitoring of the standard of the care plans, medication and other health related records to achieve a consistent standard throughout the home. The home has carried out all health and safety checks. Fire drills and fire alarm testing are regularly undertaken, call points on the alarm system are tested weekly and the emergency lighting is tested monthly. Water, freezer and refrigerator temperatures are also recorded regularly. The chef has met with the Food Hygiene Inspector and the ‘Safer food, better business’ manual has been implemented and is completed on a daily basis by the chef and monitored weekly by the manager. The home has enrolled in the DOH ‘Essential steps to infection control’ programme and has completed an ‘Essential steps self assessment tool’ and purchased colour coordinated cleaning equipment as part of the programme. All staff have undertaken moving & handling and first aid training, which are updated on a regular basis. Residents’ files that were examined showed that all risk assessments are being reviewed on a regular basis or when a change in need is identified. DS0000034878.V321707.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 3 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 3 3 3 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 3 2 3 DS0000034878.V321707.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 5 Requirement Timescale for action 31/03/07 2. OP19 16(g) 3. OP31 9 4. OP31 10(1) The registered provider must ensure that the service user guide is produced in a format i.e. pictorial, to ensure that all residents are given the opportunity to understand the information being given to them. The registered provider must 30/06/07 ensure that the kitchen sink is replaced and that the cupboards are fit for the purpose. The registered provider must 30/06/07 ensure that the registered manager undertakes a relevant management qualification. The registered manager must 31/03/07 have dedicated time to carry out her managerial duties RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations DS0000034878.V321707.R01.S.doc Version 5.2 Page 29 1 OP30 Staff that are undertaking a supervisory role would benefit from attending a supervisor’s training course. DS0000034878.V321707.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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