Inspection on 13/05/08 for Alpine Villa

This inspection was carried out on 13th May 2008.

CSCI found this care home to be providing an Adequate service.

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

Alpine Villa 25/06/07

Alpine Villa 27/06/06

Alpine Villa 11/10/05

Alpine Villa 18/04/05

Alpine Villa 22/09/04

Alpine Villa 17/07/04

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Alpine Villa 70 Lowbourne Melksham Wiltshire SN12 7ED Lead Inspector Elaine Barber Unannounced Inspection 13th May 2008 10:40 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 Alpine Villa DS0000028251.V361644.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. Alpine Villa DS0000028251.V361644.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Alpine Villa Address 70 Lowbourne Melksham Wiltshire SN12 7ED 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) 01225 706073 Mrs Luzuisminda Mercer Mrs Luzuisminda Mercer Care Home 15 Category(ies) of Dementia - over 65 years of age (15), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (15) Alpine Villa DS0000028251.V361644.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The maximum number of service users who may be accommodated in the home at any one time is 15 25th June 2007 Date of last inspection Brief Description of the Service: Alpine Villa is a private residential care home offering accommodation and personal care to a maximum of 15 residents who are over the age of 65 with either dementia and/or mental disorder. The home is a large Victorian house, close to the centre of the market town of Melksham. Residents’ accommodation consists of three shared and nine single bedrooms, one of which has en-suite facilities. Residents bedrooms are located on the ground and first floors and are reached by stairs. The home has a loungedining room, a conservatory, an additional lounge and separate dining room. Information about the service is available in a combined statement of purpose and service user guide. The fees range between £410 and £500 per week. Alpine Villa DS0000028251.V361644.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This inspection included a visit to the home on 13th May 2008 when they did not know we were going to call. We gathered evidence during the visit through: • • • • Talking with the manager, deputy and two members of staff. Talking with five people who lived in the home. Observing some of the routines of the home. Looking at records, including personal files. Other information has been taken into account as part of this inspection: • The manager sent us an Annual Quality Assurance Assessment (referred to as the AQAA) that was completed by the deputy manager. The AQAA is the provider’s own assessment of how well they are performing. It also provides information about what has happened during the last 12 months. Surveys that were completed by two people who lived in the home, two relatives, and three staff. Notifications and reports that we have received about the home since the last key inspection. • • The judgements contained in this report have been made from all the evidence gathered during the inspection, including the visit. What the service does well: People had sufficient information to make an informed decision about whether to move into the home. Information about the service was made available in a statement of purpose and service user guide. Each person also had a contract and statement of terms and conditions so that they knew what to expect from the service. Each person’s social, health and personal care needs were assessed in detail to ensure that all their needs would be met. People’s personal and health care needs were generally being met. Each person had a care plan to ensure their assessed needs would be met. The plans were detailed and they were reviewed monthly to ensure that they reflected people’s changing needs. The outcomes people wanted to achieve were recorded in their plans. There was a policy about medication. Staff had received training about medication, medicines were stored safely and Alpine Villa DS0000028251.V361644.R01.S.doc Version 5.2 Page 6 appropriate records were kept. People were helped to take their medication in a safe manner. People were treated with respect and their right to privacy was upheld. People’s social and recreational needs were being met. People’s choices of hobbies and activities were recorded to ensure they were offered the right activities. Some people went out shopping with staff support and one person did their own banking. People kept in contact with their families and friends as they wished. People, within their capabilities, could exercise personal autonomy and choice. We saw people choosing to spend time in different rooms and moving about the home freely. People received a varied and balanced diet in pleasant surroundings. They told us that they enjoyed the food. There was a complaints procedure and people were given information about this. If people were unhappy with the care home, they or their relatives knew how to complain. Staff had received training about how to recognise abuse and were aware of the procedures so that people were safeguarded from abuse and harm. People lived in a safe, comfortable, clean and well maintained environment. There was a choice of sitting and dining rooms, which were comfortably furnished. These included a conservatory, a lounge with a dining table, a dining room with a seating area and a large lounge near the front of the house. People had enough shared space and enough toilets and washing facilities to meet their needs. They had safe, comfortable bedrooms with their own possessions around them. There were at least two staff on duty at all times and sometimes three. This meant that there were enough staff on duty to meet people’s needs. People benefited from being cared for by staff who had a range of experience and training to meet their needs. Training included first aid, food hygiene, manual handling, medication management, abuse awareness and dementia awareness. The recruitment practices ensured that people were protected. New care staff had two written references and Protection of Vulnerable Adults checks before they started to work with people and all staff had Criminal Records Bureau (CRB) checks. People could have confidence in the care home because it was led and managed by people who had relevant experience. People or their families managed their money, small sums of money were managed by the care home in their best interests. The deputy had started to seek the views of people and their relatives so that improvements could be based on people’s views. People were cared for by workers who were well supported by their managers. The environment was generally safe for them and staff because the managers and workers on the whole carried out good health and safety practices. In the surveys we asked people who lived in the home, their relatives and the staff ‘What does the service do well?’ One staff member said ‘Residents are Alpine Villa DS0000028251.V361644.R01.S.doc Version 5.2 Page 7 always clean and happy.’ Another staff member said ‘Residents are all clean, their environment as well. Residents are given special attention according to their special needs. Residents were referred immediately to their GP when they’re not feeling well and given medical attention.’ They also said ‘The service has a real homely atmosphere, not institutional at all/relaxed, comfortable –the home is small therefore there is a family feel to it. The priority of the carers is to care for the residents. The home is usually clean.’ A relative said ‘Treats people as human beings. Treats people with respect. Genuinely cares for the residents.’ They also said ‘From my perspective I cannot think of any improvements needed. I am very satisfied with the service provided.’ The other relative said ‘They are so friendly and affectionate to the residents.’ What has improved since the last inspection? Staff had received training about prevention of abuse and the safeguarding vulnerable adults procedures. This would ensure that staff knew how to recognise abuse and respond to allegations so that people were kept safe. The owners had made several improvements to the accommodation since the last inspection so that people were more comfortable and had more choice about where to spend their time. These included creating a new lounge dining room, redecorating some of the bedrooms and the bathroom, changing some of the furniture and laying new carpets in some of the bedrooms. They had also bought a new tumble drier so people had clean washing returned to them quickly in wet weather. A hold open device approved by the fire authority had been fitted to one person’s bedroom door so that they could keep their door open safely. We made a requirement at the last inspection that all staff must receive training about first aid, food hygiene, manual handling and health and safety training. The staff records showed that this had almost been addressed. Staff received training in manual handling, first aid, medicine management, food hygiene and dementia awareness. Improvements had been made to the recruitment practices so that new staff had all the required checks before they started to work with people. This meant people were not cared for by staff who may be unsuitable. The deputy had made some improvements to the management of the home. She had recently completed the registered managers award and was developing the quality assurance process although this needed further work. In response to a requirement the portable electrical appliances had been checked by an electrician to ensure that they were safe fro people to use. In response to another requirement the manager and deputy had notified the Commission of a significant event since the last inspection. Alpine Villa DS0000028251.V361644.R01.S.doc Version 5.2 Page 8 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. Alpine Villa DS0000028251.V361644.R01.S.doc Version 5.2 Page 9 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 Alpine Villa DS0000028251.V361644.R01.S.doc Version 5.2 Page 10 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, Quality in this outcome area is good. People had sufficient information to make an informed decision about whether to move into the home. Each person also had a contract and statement of terms and conditions so that they knew what to expect from the service. Each person’s needs were assessed in detail to ensure that all their needs would be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There was a combined statement of purpose and service user guide. We saw that a copy of this was displayed in the front hall. It contained most of the required information except the complaints procedure section. This had information about how to contact the National Care Standards Commission. This needs to be changed to include information about how to contact the Commission for Social Care Inspection. Two people who lived in the home completed surveys that we sent to them. We asked them ‘Did you receive Alpine Villa DS0000028251.V361644.R01.S.doc Version 5.2 Page 11 enough information to decide whether this is the right place for you?’ One said that they did and the other did not answer this question. In the AQAA the manager stated that each person has an assessment of needs by the manager or deputy. We looked at the care records of three people who lived in the home. We found that each of these people had an assessment of their social, health, nutritional and personal care needs. Risks were identified in the assessments including the risks of falling and developing pressure sores. We saw that two people had a contract with Alpine Villa, which told them their terms and conditions. These had been signed on their behalf by relatives. The third person had a contract with the county council, who paid for their care, and the home. Alpine Villa DS0000028251.V361644.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 Quality in this outcome area is adequate. Most of people’s personal and health care needs were being met. Risks were assessed but this did not always ensure people were kept safe. People were helped to take their medication in a safe manner. People were treated with respect and their right to privacy was upheld. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at the care records of three people. Each had a care plan, which included the outcome that they wished to achieve from their care. Two people’s plans were signed by their key worker and the deputy and were dated. One person’s plan was not signed or dated. They had a sheet in their file about agreement to their care plan but this was not signed or dated. None of the three people nor their representative had signed their plan to show that they were involved in developing them and were in agreement with them. Alpine Villa DS0000028251.V361644.R01.S.doc Version 5.2 Page 13 The care plans were detailed and covered all aspects of their care. However, they tended to reflect the care needed rather than be person centred. One person also had a record of their preferred daily routine. Care plans were reviewed monthly and changes were recorded. We asked people in their survey forms whether they received the care and support they needed. Two people responded and said that they always did. We asked them if they received the medical support they needed. One said that they always did and the other said usually. One relative who completed a survey said that the home always met the care needs of their relative and gave the support or care to their relative that they expected or had agreed. The other relative said that they usually did. We asked the staff in their surveys if they felt they had the right support, experience and knowledge to meet the different needs of people for example in relation to age, gender, race and religion. One member of staff said that they always did, one said usually and one said sometimes but did not explain why. We also asked if they were given up to date information about the needs of the people they supported or cared for, for example in a care plan. Two staff said that they always did and one said usually. One staff member also said that up to date information was given at handover. We noted that people’s contact with health professionals was recorded in their files. These included appointments with the GP, district nurse, community psychiatric nurse, podiatrist and optician. One person had a record of treatment by the district nurse. Risks were identified in the assessment and care plan. Each person also had risk assessments with action taken to reduce risks. One person had risk assessments in relation to falls, bathing and showering. Another person had a risk assessment in relation to playing with water. However, the risks were identified in relation to damage to the building rather than the risks to the person, for example, of scalding. The manager told us that the staff usually run water for people when bathing and washing. We noted when checking the health and safety measures that the temperature of the water was regulated on the tank. However, the control measures to reduce the risk of scalding were not identified in this person’s risk assessment. People also had manual handling assessments. There was a medication policy. No-one was assessed as being able to manage their own medication. Therefore, all medication was administered to people by staff. Some of the staff had completed the ‘Safe Handling of Medicines’ course. Each person had a record of the medicines they took in their personal file. A monitored dosage system was used. The medication was stored in a locked cupboard. There was a second double locked cupboard for controlled drugs. There was a separate book to record controlled drugs. This was a ruled line book modified for the purpose by the deputy but was not a controlled Alpine Villa DS0000028251.V361644.R01.S.doc Version 5.2 Page 14 drugs register. The administration of controlled drugs was recorded in this book with two staff signatures. There were records of medication received into the home and medication administration record sheets. These were appropriately recorded. There was a book to record medication returned to the pharmacist. However, when medication was returned the pharmacist had not signed the record. The pharmacist visited every three months and gave advice about medication. Comments were contained within the home’s statement of purpose and service users’ guide, which confirmed the core values of good practice such as privacy, dignity, choice, independency and fulfilment. The aim of the home was to retain as much privacy as possible for the people who lived there. The issue of respecting peoples’ privacy was covered during staff induction. Observations and discussions with management and people who lived in the home confirmed that people could choose where to spend their time and who and where to see any visitors. People had access to a phone. People who were able dealt with their own mail. However, the manager dealt with the vast majority of people’s official mail and staff assisted people to understand the contents of any cards and other letters addressed to them. Locks had been fitted to the toilets and bathrooms. The toilet by the main lounge-dining room had been enlarged and this ensured that people’s privacy was maintained as the door was kept closed when it was used. The manager said that they were planning to build an extension to increase the number of single rooms and ensure privacy. At the time of the inspection the shared rooms were being used as single rooms. The manager and deputy said that people had the choice to bathe or shower every day. They said that people were always offered a bath or shower if they were incontinent. They also said that they thought it was important to support people to keep clean to maintain their dignity. Alpine Villa DS0000028251.V361644.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, 15 Quality in this outcome area is good. People’s social and recreational needs were being met. People kept in contact with their families and friends as they wished. People, within their capabilities, could exercise personal autonomy and choice. People received a varied and balanced diet in pleasant surroundings. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There was information in the statement of purpose and service user guide about the activities provided in the home. People’s interests and hobbies were recorded in their care plans. We saw the activities for the day recorded on a board outside the lounge. One person told us that they liked to help out in the kitchen preparing vegetables and washing up. Another person told us that they had been hanging out the washing. Two people who completed survey forms said that there were usually activities in the home that they could take part in. On the day of our visit there was a sing-along and people were playing a game of matching pairs. Some people were doing a puzzle and later they were listening to music and looking at magazines. Some people were Alpine Villa DS0000028251.V361644.R01.S.doc Version 5.2 Page 16 sitting in the garden. A member of staff told us that they would style some people’s hair in the evening. In the AQAA the manager told us that they provided a range of daily activities and celebrated festivals such as Christmas and birthdays. They also said that some residents go out into the community. During our visit the manager told us that she took people shopping into town and to the park. She said that one person went to the bank. One relative told us in their survey that their relative was taken to church. There was information in the statement of purpose and service user guide stating that visitors were welcome in the home at any time. There were records in the personal notes about visits from and to relatives. There was a quiet lounge at the front of the house, which could be used to meet with visitors in private. People could also see visitors in the privacy of their rooms. There was information about maintaining privacy, dignity, choice and independence in the home’s statement of purpose and service users’ guide. People had brought items of furniture and personal possessions to make their bedrooms more homely. They could make their own drinks, choose where to spend their time, where to eat, and what activities to participate in. Staff support was provided to those people who needed help to choose what clothes to wear. One person handled their own finances. People’s preferred daily routines were recorded in their care plans. People were involved in the daily routines as they chose, for example in meal preparation, hanging out the washing and washing up. The manager had changed the accommodation around to create another lounge dining room. This meant that people had more choice of where to sit and spend time and where to eat their meals. One relative said in their survey form that the home always supported people to live the life they chose. Menus were planned in advance. They showed that a variety of meals were served to give a balanced diet. There was a choice of breakfast and tea and a set meal for lunch. Supper was also served and drinks were available throughout the day. Special diets were catered for. Two people had gluten free diets. The menus were adapted to accommodate this. One person was involved in their own meal preparation and said that they enjoyed their meals and enjoyed preparing the vegetables. Three other people said that they enjoyed their lunch and the food was very good. Two people said in their survey forms that they always enjoyed the meals in the home. People could eat their meals in the conservatory, lounge or one of two lounge-dining rooms. One person chose to have their meals in their room. The manager had identified in the AQAA that they could improve the menus by involving people more in menu planning. Alpine Villa DS0000028251.V361644.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. If people were unhappy with the care home, they or their relatives knew how to complain. Staff had received training about how to recognise abuse and were aware of the procedures so that people were safeguarded from abuse and harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We saw a copy of the complaints procedure within the home’s statement of purpose and service users’ guide. This needs to be updated to include the new contact details of the Commission. The home and the Commission have not received any complaints since the last inspection. There was a comments book in the front hall but no-one had put any comments in it. In the AQAA the deputy said that they could make people and their relatives more aware of this so they could give comments about how the service could improve. Two people said in their surveys that they always knew who to speak to if they were not happy. Both knew how to make a complaint. One relative could not remember how to make a complaint but said that if they needed to they were sure they could find out. The other relative could not remember how to make a complaint. One relative said that the care service always responded appropriately if they or their relative raised concerns about the care and the other said that they usually did. Alpine Villa DS0000028251.V361644.R01.S.doc Version 5.2 Page 18 There was a policy and procedure about responding to suspicion or evidence of abuse and all staff had been given a copy of the shortened version of the Wiltshire and Swindon Vulnerable Adults procedures. Staff who were undertaking National Vocational Qualifications (NVQ) at Level 2 covered protecting from abuse in the NVQ. There had been no allegations of abuse. We made a requirement at the last inspection that all staff must receive training about abuse awareness and prevention from abuse so that they know how to recognise abuse. In the AQAA the deputy told us that all staff have received training about abuse and recognising abuse. During our visit the manager, deputy and a member of staff told us that a police officer had visited the previous day to talk to staff about prevention from abuse and the safeguarding vulnerable adults procedures. Three staff said in their surveys that they knew what to do if a person who lived in the home or a relative had concerns about the home. Alpine Villa DS0000028251.V361644.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 24, 26 Quality in this outcome area is good. People lived in a safe, comfortable, clean and well maintained environment. People had enough shared space and enough toilets and washing facilities to meet their needs. They had safe comfortable bedrooms with their own possessions around them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The premises were maintained to a reasonable standard and offered suitable heating, lighting and ventilation. The majority of the decoration in the home was maintained to a good standard. The home provided sufficient communal space consisting of a lounge-dining room, a conservatory, a separate dining room with a seating area and an additional lounge to the front of the property. These areas were suitably furnished and decorated. The home also provided a Alpine Villa DS0000028251.V361644.R01.S.doc Version 5.2 Page 20 small, enclosed rear garden, which was used by some people, particularly those who smoked. The home provided a sufficient number of bath, shower and toilet facilities, which were located close to people’s bedrooms and the communal rooms. The toilet close to the main lounge-dining room on the ground floor had been enlarged to provide more appropriate facilities to meet the needs of people. There were also two very small toilets located on the first floor. The home had three shared bedrooms and nine single bedrooms, two of which were provided with en-suite facilities. People’s bedrooms were located on the ground and first floor levels. There was a staircase to the first floor. All rooms were fitted with a call bell system, which people could use to summon staff assistance if required. People’s bedrooms were adequately furnished and decorated. People had brought items of personal possessions to make their rooms more homely. Two people who completed comment cards said that the home was always fresh and clean. The deputy told us in the AQAA that they had made several improvements to the accommodation since the last inspection. These included creating a new lounge dining room, redecorating some of the bedrooms and the bathroom, changing some of the furniture and laying new carpets in some of the bedrooms. We saw these changes during our visit. The home was maintained to a reasonable standard and was clean and tidy. The laundry room was located on the ground floor and provided adequate facilities to meet the needs of people who lived in the home. However, one relative commented in their survey that the standard of washing and stain removal on clothes had declined recently. During our visit we observed that people’s clothes were clean and pressed. People’s clothing was labelled and each person had a named basket in the laundry to store washed clothes. This was to ensure that clothes were returned to the right person. At the last inspection we made a requirement that suitable facilities must be provided for drying washing in wet weather. The deputy said in the AQAA that they had bought a new tumble drier and we saw this during our visit. Alpine Villa DS0000028251.V361644.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is generally good. There were sufficient numbers of staff on duty at all times to meet people’s needs. People benefited from being cared for by staff who had a range of experience and training to meet their needs, although more staff needed training about health and safety. The recruitment practices ensured that people were protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The rota showed that there were at least two staff on duty during the day and evening and a cleaner every other day. The deputy said that there were sometimes three staff on duty but there were only two when staff took holidays. At night there was one waking member of staff and one staff member sleeping in. We asked the staff in their surveys whether there are enough staff to meet the individual needs of all the people who use the service and the two staff who answered said that there usually were. In answer to the question ‘What could the service do better?’ one staff member said ‘More staff needed’ and the other said ‘Additional staff during the night shift.’ The two people who completed surveys said that staff were always there when they needed them. Alpine Villa DS0000028251.V361644.R01.S.doc Version 5.2 Page 22 We made a requirement at the last inspection that all staff must receive training about first aid, food hygiene, manual handling and health and safety training. The staff records showed that this had almost been addressed. Staff received training in manual handling, first aid, medicine management, food hygiene and dementia awareness. However, only the owner and the deputy had received training about health and safety. Nine staff had also received training about prevention of abuse the previous day. Five staff were booked on a food hygiene course the week after the inspection. A new member of staff was in their probationary period and had not yet had all the training. One member of staff had a National Vocational qualification (NVQ) at level 2 and level 3 and one had an NVQ at level 2. Four more staff had just completed NVQ level 2. Two other staff had general nursing qualifications from their country of origin. We spoke to two staff who said that they always took any training which was offered and they enjoyed the training. We asked staff in their surveys ‘are you being given training which is relevant to your role, helps you to understand the individual needs of people and keeps you up to date with new ways of working?’ All three staff who answered said that they were. One said that ’Any training I require I request and I take any training offered by Alpine Villa.’ One relative said in their survey that the care staff always had the right skills and experience to look after people properly. The other said that staff usually had the right skills and experience. New staff had an induction to the home. We saw the induction folder, which was given to the newest member of staff to read. This did not follow the skills for care common induction standards. We asked the staff in their surveys ‘did your induction cover everything you needed to know to do the job when you started?’ One said that it covered everything very well and one said that it mostly covered things. We looked at the recruitment records of one new member of care staff. This carer had completed an application form. They had made a declaration about convictions on the form. The staff member had a copy of their birth certificate and photo driving license as proof of identity. They had two written references and a Protection of Vulnerable Adults (POVA) first check before they started to work with people. The deputy said that they worked under supervision before their CRB check was received four days after they started work. We made a requirement at the last inspection that new staff must have two written references before they start to work with people. This had been addressed and the owners had received two written references for this staff member before they started work. Alpine Villa DS0000028251.V361644.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 38 Quality in this outcome area is adequate. People could have confidence in the care home because it was led and managed by people who had relevant experience although the registered manager should be qualified. People or their families managed their money, small sums of money were managed by the care home in their best interests. The quality assurance measures do not fully reflect people’s views to ensure that the home is run in their best interests. People were cared for by workers who were well supported by their managers. The environment was generally safe for them and staff because the managers and workers on the whole carried out good health and safety practices although staff needed further training. This judgement has been made using available evidence including a visit to this service. Alpine Villa DS0000028251.V361644.R01.S.doc Version 5.2 Page 24 EVIDENCE: The manager had many years’ experience in both management of a relevant care setting and in a supervisory role. She had a relevant nursing qualification but she had not completed a relevant management qulaification. The manager was supported in the day to day management of the home by her deputy manager who had just completed the Registered Managers’ Award. The deputy manager had increasingly taken over all aspects of the day to day management of the home and will eventually apply to be the registered manager. The training records showed that the manager and the deputy kept their training about basic care practice up to date. They had received training about dementia awareness. Most of the requirements from the last inspection had been addressed. However two requirements in relation to developing quality assurance in the home and training staff about health and safety are outstanding. One person managed their own money. The manager took two people to collect their pensions and they kept their own money. Relatives or solicitors managed the money for other people. The home kept small amounts of money for people for hairdressing. A record of this was kept in the daily diary or the personal notes. The manager and deputy had started to collect the views of people. They sent out twelve questionnaires in January 2008 and they received three replies. The deputy said that relatives made comments and staff acted upon them. In the AQAA the deputy said that they planned to develop quality assurance further. She said that she wanted to obtain more feedback from the people who lived in the home and their relatives. We made a requirement at the last inspection that the registered person must establish a system for reviewing and improving the quality of the service based on the views of people who use the service. The deputy said that they were still developing this and was disappointed in the low response to their questionnaires. The deputy had not obtained any specialist advice about involving people with dementia in developing the quality of the service. The deputy had received training about supervision and had introduced supervision contracts and a structured method for recording supervision. The deputy said that she had not conducted formal one to one supervision meetings for about ten months and there had been no annual appraisals either. However, she stated that she provided informal supervision for staff on a daily basis but this was not recorded. We asked the staff in their surveys ‘Does your manager meet with you to give you support and discuss how you are working? One staff member said that they met with their manager regularly and ‘my manager/deputy are regularly on the premises and available for one on one meetings.’ The other said that they met often. Alpine Villa DS0000028251.V361644.R01.S.doc Version 5.2 Page 25 A copy of the Health and Safety Act was on display within the home. The deputy had attended a health and safety course, which included risk assessment. Since the last inspection most staff had receive the required mandatory training although more staff needed training about health and safety. There were certificates to show that the boiler, the hoists, and the electrical wiring were serviced. We made a requirement at the last inspection that portable electrical appliances must be regularly checked and tested. These had been checked and we saw the record of portable appliance testing. The upstairs windows were restricted and the temperature of the hot water was regulated on the tank. Radiators were covered. There was a fire risk assessment. At the last inspection we noted that one person liked to keep their bedroom door open and occasionally used wedges. We made a requirement that doors must only be held open by a device approved by the fire officer. An appropriate device had been fitted. There were magnetic hold open devices on all the main fire doors. Examination of the fire log book showed that all the checks and tests were occurring at the required times although the fire instruction for staff was due A requirement was made at the last inspection that the owner must provide the Commission with notification of any death, illness and other events relating to welfare of people. There had only been one event and the Commission had been notified of this. In the surveys we asked people who lived in the home, their relatives and the staff ‘What does the service do well?’ One staff member said ‘Residents are always clean and happy.’ Another staff member said ‘Residents are all clean, their environment as well. Residents are given special attention according to their special needs. Residents were referred immediately to their GP when they’re not feeling well and given medical attention.’ They also said ‘The service has a real homely atmosphere, not institutional at all/relaxed, comfortable –the home is small therefore there is a family feel to it. The priority of the carers is to care for the residents. The home is usually clean.’ A relative said ‘Treats people as human beings. Treats people with respect. Genuinely cares for the residents.’ They also said ‘From my perspective I cannot think of any improvements needed. I am very satisfied with the service provided.’ The other relative said ‘They are so friendly and affectionate to the residents.’ Alpine Villa DS0000028251.V361644.R01.S.doc Version 5.2 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 3 3 3 X x X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 3 X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 x 2 Alpine Villa DS0000028251.V361644.R01.S.doc Version 5.2 Page 27 Yes Are there any outstanding requirements from the last inspection? 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 OP33 Regulation 24 Requirement The registered person must establish a system for reviewing and improving the quality of the service based on the views of people who use the service. The registered person must make sure that all staff receive training about health and safety. Timescale for action 31/08/08 2 OP38 18 (1) 31/08/08 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. 2. 3. Refer to Standard OP7 OP7 OP7 Good Practice Recommendations Each person, or a representative should sign their care plan to show that they have been involved in developing it and are in agreement with it. Risk assessments should include all risks to the person and the action and measures required to reduce these risks to ensure that people are kept safe. The care plans should be developed further to make them more person centred to ensure that people receive individualised care. Advice should be sought from a DS0000028251.V361644.R01.S.doc Version 5.2 Page 28 Alpine Villa 4. 5. OP9 OP9 6. 7. 8. 9. 10. 11. 12. OP16 OP30 OP33 OP31 OP31 OP36 OP36 specialist organisation about care planning with people with dementia. A controlled drugs register should be obtained to record the administration of controlled drugs. The registered person should obtain advice from the pharmacist about whether the current controlled drugs cabinet meets the new requirements for the storage of controlled drugs. Relatives should be reminded about how to make a complaint about the service. New staff should have an induction using the skills for care common induction standards. Advice should be sought from a specialist organisation about how to involve people with dementia in assessing quality and developing the service. The registered manager should hold a relevant management qualification. The manager and deputy should receive more in depth training about developing a service for people with dementia to keep their practice up to date. All staff should receive formal one to one supervision at least six times a year and a record should be kept. All staff should have an annual appraisal. Alpine Villa DS0000028251.V361644.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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