CARE HOMES FOR OLDER PEOPLE
Alpine Villa 70 Lowbourne Melksham Wiltshire SN12 7ED Lead Inspector
Elaine Barber Unannounced Inspection 10:55 25th and 26th June 2007 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.V336259.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.V336259.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.V336259.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 27th June 2006 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, which is located in the market town of Melksham close to all local amenities. 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 the 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.V336259.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection included one unannounced visit to the home on 25th June 2007 and a planned visit on the 26th June. During the visits information was gathered through: • • • • • • Observation Discussion with people who lived in the home Discussion with the manager Discussion with the deputy manager Discussion with staff Reading records. Other information and feedback about the home has been received and taken into account as part of this inspection: • • • • • The manager provided information prior to the inspection about the running of the home. Comment cards were received from two people who lived in the home. Comment cards were received from two relatives and visitors. Comment cards were received from four members of staff. A comment card was received from a care co-ordinator. The judgements contained in this report have been made from all this evidence gathered during the inspection, including the visits. What the service does well:
There was a statement of purpose and service user guide. People who were interested in moving into the home were given a copy. This ensured that people had sufficient information to make an informed decision about whether to move into the home. Each person had a detailed assessment of their personal, social and health care needs to ensure that all their needs would be met. Each person also had a contract and statement of terms and conditions so that they knew what to expect from the service. Support with personal, social and health care needs was recorded in each person’s care plan. The plans were very detailed to ensure that people’s personal, health care and diversity needs were being met. People were helped to take their medication in a safe manner. Staff who administered medication had training. Medication was stored safely and the required records were kept accurately.
Alpine Villa DS0000028251.V336259.R01.S.doc Version 5.2 Page 6 Each person had their own room and people had brought personal items into their rooms to make them individual and homely. People were treated with respect and their right to privacy was upheld. People found that the lifestyle in the home suited their needs, wishes and choices. Each person had a record of their preferred routine to ensure that routines were flexible to meet their needs. Staff arranged activities every morning and afternoon. People who were able could go out. People kept in contact with family and friends and went out into the community. Visitors were welcome in the home at any time. People went out with their relatives and the staff also took them out individually and in groups. People had opportunities to exercise choice and control over their lives. They were involved in the routines of the home when able. There was a varied menu to give a balanced diet. Special diets were catered for. People had a choice of meals and they enjoyed their food. There was a complaints procedure and people and their relatives were given information about how to complain. If people were unhappy with the care home, they or their relatives knew how to complain. There was a policy and procedure about protection from abuse. Staff were aware of the procedure. Some staff had received training about prevention of abuse. People could be sure that staff would know how to respond if an allegation of abuse was made. There was a lounge dining area, a conservatory, a second lounge and a dining room. The accommodation was cleaned to a good standard. Most of the rooms were single, although there were three shared rooms. Some of the rooms had ensuite facilities. There were toilets close to the communal rooms and to the bedrooms. The laundry facilities, when working, were large enough for the needs of people who lived in the home. People lived in a safe, comfortable, well-maintained environment, which was clean pleasant and hygienic. 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 sufficient numbers of staff on duty at all times to meet people’s needs. At the time of the inspection ten people were living in the home. There were usually two care staff on duty during the day and one waking and one sleeping member of night staff. There was an additional staff member at busy times. People benefited from being cared for by staff who had a range of experience to meet their needs. The manager had a nursing qualification and several years’ experience of managing a care home. Both she and the deputy manager were working towards the Registered Managers’ Award. People could have confidence in the care home because it was led and managed by people who had relevant experience. People who were able managed their money and families or solicitors managed the money of some other people. Staff managed small
Alpine Villa DS0000028251.V336259.R01.S.doc Version 5.2 Page 7 sums of money on behalf of some people and their interests were safeguarded by the records kept. The deputy had received training about supervision and was providing regular supervision to staff. People were cared for by workers who were supervised and 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. What has improved since the last inspection? What they could do better:
The tumble dryer should be replaced so that laundry can be dried quickly and easily in wet weather. This will ensure that people always have their clothes returned to them promptly after laundering. Alpine Villa DS0000028251.V336259.R01.S.doc Version 5.2 Page 8 The recruitment practices within the home require further improvement to ensure that people are protected. All staff must receive training about prevention from abuse so that they know how to recognise abuse. All staff must also receive training in first aid and food hygiene and more staff need to complete a National Vocational Qualification (NVQ) so that people are cared for by staff who are appropriately trained and qualified. A system must be developed for reviewing and improving the quality of the service. This must be based on the views of people who use the service to ensure that the service is run in their best interests. Mrs Mercer must ensure that the Commission is notified of any death, illness and other events relating to residents by way of Regulation 37 Notices and these are completed in sufficient detail. The practice of wedging fire doors must be stopped. Fire doors must not be held open unless with a device approved by the fire authority to ensure that they will work effectively and people are kept safe in the event of a fire All portable electrical appliances should be inspected and tested regularly to ensure that people are kept safe. 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.V336259.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.V336259.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. This judgement has been made using available evidence including a visit to this service. 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. EVIDENCE: There was a combined statement of purpose and service user guide. A copy of this was placed in the entrance hall of the home. There was a requirement at the last inspection that the statement of purpose must contain all relevant information. This copy in the hall had not been updated. However, the deputy manager produced an updated copy from the office. Information about fire precautions and associated emergency procedures and the arrangements for reviewing care plans had been added. All the required information about the
Alpine Villa DS0000028251.V336259.R01.S.doc Version 5.2 Page 11 service was included. The deputy manager said that a copy of this revised statement of purpose and service user guide was given to people who were thinking about moving into the home. The two people who completed comment cards said that they received enough information to help them to decide if the home was the right place for them. At the time of the inspection ten people were living in the home and two people were in hospital. The care records of four people were seen. Three of these had an old style assessment with very detailed information about their needs. One person had a new style assessment which relied on a scoring system rather than written information and was not so detailed. Each person had a contract. People who paid for their own care had a statement of terms and conditions and a contract with the home. People whose care was paid for by social services had a contract with social services and the home. Alpine Villa DS0000028251.V336259.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 good. This judgement has been made using available evidence including a visit to this service. People’s personal, health care and diversity needs were being met. People were helped to take their medication in a safe manner. People were treated with respect and their right to privacy was upheld. EVIDENCE: There were detailed care plans for all the people who lived in the home. They were informative and were supplemented by a daily routine information sheet. This included information about people’s preferences regarding their daily routines, personal care, food, mealtimes, hobbies and interests. Four care plans were read in detail. Three of these were old style care plans, which were written and provided clear information about how people’s needs were to be met. The fourth was a new style care plan which relied on a tick box system with little comment so it was not so easy to understand. Each of
Alpine Villa DS0000028251.V336259.R01.S.doc Version 5.2 Page 13 these four people also had a daily routine, which included their preferences for meals, holidays and interests. The care plans were not signed or dated. Care plans were reviewed monthly by staff in the home. A requirement was made at the last inspection that all placements must be reviewed with all relevant parties. This had been addressed and reviews were being carried out every six months to a year with social services representatives. Social services then provided a copy of the review notes. Individual risk assessments had also been established for people and these were also being reviewed. A recommendation was made at the last inspection that the registered individual should strongly consider developing the content of residents’ risk assessments. This had been addressed. Risks were identified in the assessments. Where a risk was identified an individual risk assessment was developed with control measures to reduce risks. There was information in the statement of purpose and service user guide about meeting people’s individual and specific needs. There was evidence that people’s diverse needs were considered in terms of their diet, preferences and choices about their lifestyles. One relative who completed a comment card said that the home always met people’s different needs. The other relative and a care professional said in their comment cards that they usually do. This relative considered that the home met needs in terms of age and disability. They also said that the home organised religious services. People who moved into the home were registered with one of two surgeries. People who were able were encouraged to attend the surgeries, for any appointments, with the assistance of staff or their families. Where this was not possible, visits would be made to the home by GPs, district nurses and other health professionals and any treatment would be carried out in the privacy of the people’s bedrooms. The need for eye care and footcare was identified in the care plan. Visits from health care professionals were recorded. The deputy manager reported that there were no pressure sores because staff encouraged people to walk throughout the day. They also reported that the continence nurse conducted assessments for people and when needed provided continence aids. There was evidence that the manager and the deputy sought advice from the mental health team when needed. However, the manager, the deputy and a member of staff said that they did not have very good support from the mental health team. The two people who completed comment cards said that they always received the medical support that the needed. One said that they had been to see the optician and dentist. The two relatives who completed comment cards said that the home always met the needs of their friend or relative. The care professional said in their comment card that the home usually met individual’s health care needs. 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’
Alpine Villa DS0000028251.V336259.R01.S.doc Version 5.2 Page 14 course. All staff had in-house training about medication and had been deemed competent by the manager, the deputy or a senior carer. 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. 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 deputy said that they would discuss this with the pharmacist. The pharmacist visited every three months. They had made a recommendation about the controlled drugs cupboard, which had been addressed. They made another recommendation about developing a homely remedies policy and the deputy said that this needed to be completed. The care professional said, in their comment card, that the home always supported individuals to manage their own medication or managed it correctly when this was possible. 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 with 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. After the toilet by the main lounge-dining room was enlarged, people’s privacy was maintained as the door was kept closed when it was used. The care professional said in their comment card that the home usually respected individuals’ privacy and dignity. Alpine Villa DS0000028251.V336259.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. This judgement has been made using available evidence including a visit to this service. People’s social, recreational, and spiritual 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. 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. If someone had a particular interest this was supported. For example, one person liked to go out for a Chinese meal with a staff member and went about once a month. Another person liked to dance and went out to tea dances. They went to a dance on one day during the inspection. The activities for the day were recorded on a board outside the lounge. On the afternoon of the first day of the inspection people were watching a film in the lounge and eating sweets. On the second day they were doing a word game in the morning and in the afternoon they played dominoes
Alpine Villa DS0000028251.V336259.R01.S.doc Version 5.2 Page 16 and snakes and ladders. Each person had a record, in their personal notes, of the activities they had followed. Activities included puzzles, bingo, word games, cards and reminiscence. One person liked to help out in the kitchen preparing vegetables and washing up. Some people were involved in cake making. One person who completed a comment card said that there were always activities in the home that they could take part in and another said that there usually were. The manager took people out shopping. One of the staff had taken people out to Laycock and strawberry picking. The manager said that she took two people to church at Christmas. However, nobody had expressed an on going religious need so no-one went to church regularly. The manager said that staff would take people to church if they wished to go. Birthdays and festivals, such as Christmas, Valentine’s day and Halloween, were celebrated. A member of staff who had trained as a hairdresser cut people’s hair, or people could go out to the hairdresser if they chose. 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. Observations and discussions with the people who lived in the home and the managers confirmed that when able, could exercise personal autonomy and choice in a number of ways. 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 and washing up. 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. One person had a dairy and gluten free diet. The menus were adapted to accommodate this. The 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 the food and it was very good. A fourth said that it was mostly good. One person who completed a comment card said that they always enjoyed the meals in the home while a second person did not answer Alpine Villa DS0000028251.V336259.R01.S.doc Version 5.2 Page 17 that question. People could eat their meals in the conservatory, lounge or dining room. One person chose to have their meals in their room. Alpine Villa DS0000028251.V336259.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, 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. If people were unhappy with the care home, they or their relatives knew how to complain. People could be sure that staff were aware of the safeguarding procedures so that they would be able to respond if an allegation of abuse was made. However people could not be sure that all staff knew how to recognise abuse so that they would be safeguarded from abuse and neglect. EVIDENCE: There was a complaints procedure and a copy of this procedure was displayed on the notice board in the hallway of the home. A further copy was also contained within the home’s statement of purpose and service users’ guide. 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. The people who were spoken to expressed no complaints or concerns. Two relatives who completed comment cards said that they knew how to make a complaint. One person who lived in the home completed a comment card and said they knew how to make a complaint. The relative of a second person who completed a comment card said that they knew how to complain. Alpine Villa DS0000028251.V336259.R01.S.doc Version 5.2 Page 19 There was a policy and procedure about responding to suspicion or evidence of abuse and all staff have been given a copy of the shortened version of the Wiltshire and Swindon Vulnerable Adults procedures. Staff who completed comment cards said that they were aware of the adult protection procedures. There had been no specific training about prevention of abuse. However, several staff were undertaking National Vocational Qualifications (NVQ) at Level 2 and abuse was covered in the NVQ. All staff would benefit from training about prevention of abuse so that they know how to recognise abuse. There had been no allegations of abuse. Alpine Villa DS0000028251.V336259.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, 23, 24, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People lived in a safe, comfortable, well maintained environment, which was clean pleasant and hygienic. 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. 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 manager had identified several areas for improvement including redecoration of some bedrooms and replacing the lounge curtains and some carpets, which were becoming worn. Alpine Villa DS0000028251.V336259.R01.S.doc Version 5.2 Page 21 A requirement was made at the last inspection that the water outlet to the hot water taps to some people’s bedroom sinks is adjusted. The water was regulated on the tank and this had been adjusted so that the temperature of the water to the wash hand basins was hot but also a safe temperature. A requirement was also made that one of the bedroom doors must be adjusted so that it closed properly and this had been done. The environmental health officer (EHO) had visited the previous Friday to inspect the food safety measures. They were satisfied with the arrangements and recommended that the fridge and freezer temperatures were recorded in one book. The EHO had conducted a health and safety inspection earlier in the year and was also satisfied with arrangements. They advised the manager to put up a health and safety poster which they had done The home provided sufficient communal space consisting of a lounge-dining room together with a conservatory, a separate dining room and an additional lounge to the front of the property. These areas were suitably furnished and decorated. The home also provided a 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 has 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. Access to the toilet for people on the first floor would be improved by converting these into one. 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. The first floor was accessed by use of a staircase. 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. People who were spoken to commented positively about the standard and cleanliness of their accommodation. Two people who completed comment cards said that the home was always fresh and clean. The home was maintained to a reasonable standard and was clean and tidy. At the last inspection there was a distinct odour in two of the bedrooms. This had been eliminated by replacing the carpet. The laundry room was located on the ground floor and provided adequate facilities to meet the needs of people who lived in the home. People’s clothing was labelled and each person had a named basket in the laundry to store washed clothes and to ensure that garments were appropriately returned. At the time of the inspection there was a large amount of wet washing in the laundry room. The deputy said that the
Alpine Villa DS0000028251.V336259.R01.S.doc Version 5.2 Page 22 tumble dryer had broken and it was difficult to dry things when the weather was wet. Alpine Villa DS0000028251.V336259.R01.S.doc Version 5.2 Page 23 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 adequate. This judgement has been made using available evidence including a visit to this service. 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 to meet their needs. The recruitment practices within the home required further improvement to ensure that people were protected. EVIDENCE: There were two care staff on duty during the day and one waking and one sleeping member of night staff. There was also a cleaner four or five days a week. The deputy said that this member of staff also helped with care tasks during busy times for example between 5pm and 8pm. The manager did the cooking. At the time of the inspection ten people were living in the home. These staffing levels were sufficient to meet their needs. The deputy said that they would increase the staffing levels when more people were admitted. Two people who were spoken to said that the staff were very good and helpful. The two people who completed comment cards said that staff were always there when they needed them. There was a training plan. All staff received induction training. There was a requirement at the last inspection that all staff must receive the required basic
Alpine Villa DS0000028251.V336259.R01.S.doc Version 5.2 Page 24 training. This had been partly met. The training records showed that most staff had received training in first aid, food hygiene, manual handling and health and safety. Two staff needed to complete food hygiene and one needed to complete first aid. Two new staff needed to complete both first aid and food hygiene. Dates had been arranged for these staff to complete the training. Two staff, the deputy and the manager had completed a course in the safe handling of medicines. Some staff had attended a one day dementia awareness course and six staff were booked on to a dementia awareness course which lasted twelve weeks. Staff received training about abuse awareness as part of induction and National Vocational Qualifications (NVQ). All staff need more in-depth training about prevention of abuse. Three staff who completed comment cards said that the home provided funding and time for them to receive relevant training. One said ‘not much’. The manager and the deputy were undertaking the Registered Managers Award. There were eleven care staff. Two had nursing qualifications from another country. Two staff had National Vocational Qualifications (NVQ) at level 2 and 3. Four staff were working towards NVQ. A requirement was made at the last inspection that a full employment history must be obtained for all new staff which shows the dates of all previous employment. This had been addressed. There had been two new staff since the last inspection. Each of them had completed an application form, which included a full employment history. They had completed a declaration on the application form that they had no offences. These two staff were recruited from abroad by an agency. Two written references and a Criminal Records Bureau (CRB) check had been obtained before they started work. For each member of staff one reference had been obtained from a person who was written to and provided an employment reference. The other was a typed testimonial from a previous employer in the country of origin. However, neither the manager nor the agency had checked that this testimonial was provided by the person who it said had provided it. Three staff who completed comment cards said that two written references and a CRB check were obtained before they started work. One member of staff did not answer this question. Alpine Villa DS0000028251.V336259.R01.S.doc Version 5.2 Page 25 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People could have confidence in the care home because it was led and managed by people who had relevant experience. People or their family 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 supervised and 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. Alpine Villa DS0000028251.V336259.R01.S.doc Version 5.2 Page 26 EVIDENCE: The manager had considerable years’ experience in both management of a relevant care setting and in a supervisory role. She had a relevant nursing qualification and had almost completed the Registered Managers’ Award. The manager was supported in the day to day management of the home by her deputy manager who had started the Registered Managers’ Award and the Assessors’ 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 when she has completed the Registered Managers’ Award. 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 wrote letters to relatives for feedback and they received four replies. They made some changes to the environment as a result. They sought the views of people through talking to them and their friends and relatives. They also obtained feedback form staff. There was no formal system of quality assurance. A recommendation was made at the last inspection that the deputy manager should attend a supervision course. The deputy had received training about supervision and had introduced supervision contracts and a structured method for recording supervision. Records of supervision were seen and they showed that practice issues and training needs were discussed. The records showed that supervision was happening regularly for each member of staff. The deputy said that supervision was happening every three months and she was aiming for it to take place every two months. Three out of four staff who completed comment cards said that they had formal one to one supervision which was planned and recorded. They said that there were also staff meetings and they had enough support to do their job well. A copy of the Health and Safety Act was on display within the home. In response to a recommendation at the last inspection 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. In response to a previous requirement one of the bedroom fire doors had been adjusted so that it closed properly. The environmental health officer had visited about two months before this inspection. They were satisfied with the health and safety arrangements and gave some advice about reviewing the risk assessments. Alpine Villa DS0000028251.V336259.R01.S.doc Version 5.2 Page 27 There were certificates to show that the boiler, the hoists and the electrical wiring were serviced. There was no record of portable appliance testing and the deputy was not sure whether this had been done. She said that she would check and ensure this was done. 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. One person liked to keep their bedroom door open and occasionally used wedges. This practice was discussed with the deputy who was advised to use a device approved by the fire officer. 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. There was a requirement at the last inspection about the recording of the date when fire instruction took place. This had been addressed. 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. A notification of a death had been received but there had also been a fall and the manager had not notified the Commission of this event. Alpine Villa DS0000028251.V336259.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 3 X 3 3 X 2 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 X X 2 Alpine Villa DS0000028251.V336259.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP18 Regulation 13 (6) Requirement All staff must receive training about abuse awareness and prevention from abuse so that they know how to recognise abuse. The registered person must provide people with suitable facilities for drying laundry in wet weather. The registered person must ensure that two written references are obtained for each new member of staff before they start work. Timescale for action 31/10/07 2. OP26 16 (2)(f) 25/06/07 3. OP29 19(1)(b) 25/06/07 4. OP33 24 5. OP38 37(1) The registered person must 31/10/07 establish a system for reviewing and improving the quality of the service based on the views of people who use the service. The registered individual must 25/06/07 ensure that the Commission is notified of any death, illness and other events relating to residents by way of Regulation 37 Notices and that these are completed in sufficient detail.
DS0000028251.V336259.R01.S.doc Version 5.2 Page 30 Alpine Villa 6. OP38 18(1) 7. 8. OP38 OP38 23(4) 13 (4)a The registered individual must ensure that all staff receive first aid, food hygiene, manual handling and health and safety training. Fire doors must not be held open unless with a device approved by the fire authority. The registered person must ensure that portable electrical appliances are regularly inspected and tested. 30/09/07 25/06/07 25/06/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP26 Good Practice Recommendations The tumble dryer should be replaced so that laundry can be dried quickly and easily in wet weather. Alpine Villa DS0000028251.V336259.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB 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
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