Inspection on 27/06/06 for Alpine Villa

This inspection was carried out on 27th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Alpine Villa 13/05/08

Alpine Villa 25/06/07

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Alpine Villa 70 Lowbourne Melksham Wiltshire SN12 7ED Lead Inspector Thomas Webber Unannounced Inspection 27th June 2006 09:25 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.V299009.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.V299009.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.V299009.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 11th October 2005 Date of last inspection Brief Description of the Service: The home 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 floor levels and are accessed by use of a staircase. The home provides a lounge/dining room together with a conservatory and additional lounge and separate dining room. Alpine Villa DS0000028251.V299009.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection conducted over a period of two days on 27th and 28th June 2006 from 09:25 to 16:55 and 08:55 to 14:50 respectively. The judgements contained in this report have been made from evidence gathered during the inspection, which included a tour of the premises and takes into account the views and experiences of six of the nine residents in situ which were sought on an individual and group basis. The views of three members of care staff, two relatives and the management of the home were also sought. Thirty one of the thirty eight Standards were assessed on this occasion which included examining records, staffing, care practices, systems, policies and procedures and feedback was provided throughout the inspection. The home has made significant strides to improve the quality of service provided to the residents and to address the large number of requirements and recommendations identified in previous inspection reports. With the ongoing assistance, monitoring and support of the Commission, it is envisaged that the home will continue to make further progress. What the service does well: Residents have been fully assessed by the home, prior to admission, to ensure that their needs can be met. Opportunities are available for prospective residents and their families to visit the home, prior to admission, to assess the quality of facilities and suitability of the home. Residents have been provided with a copy of the home’s written contract or the placing authority’s terms and conditions. Care plans have been established for all residents. Residents’ health care needs are being suitably met and suitable procedures have been established for dealing with residents’ medication. However, residents are not deemed capable of maintaining control for their medicines. Residents’ rights to privacy are respected. Residents’ social, recreational, and spiritual needs are being suitably catered for and residents maintain contact with their families and friends in accordance with their individual circumstances. Residents, within their capabilities, can exercise personal autonomy and choice and residents receive a varied and balanced diet with meals being taken in a congenial and relaxed setting. Residents who commented about the quality and quantity of food provided stated that the food was adequate to good. Residents are provided with appropriate information on how to complain and they felt confident that any complaints would be listened to and acted upon. Alpine Villa DS0000028251.V299009.R01.S.doc Version 5.2 Page 6 Appropriate procedures have been established to protect the residents from abuse and staff are aware of these. The location and layout of the home is suitable for its stated purpose. All parts of the home are accessible, safe and suitably maintained to meet the residents’ individual and collective needs and provides sufficient communal facilities. The home continues to be maintained to a reasonable standard being clean, tidy, comfortable, suitably furnished and decorated, although there are some areas which require improvement. The home provides a sufficient number of toilets and bathrooms. Residents’ bedrooms are suitable to meet their needs and residents have personalised them to their individual wishes. Residents spoken to commented positively about the standard and cleanliness of their accommodation. The home provides appropriate laundry facilities to meet the needs of the residents. Residents also commented favourably about the laundry arrangements in place. The home is run and managed by persons who are appropriately qualified and have sufficient experience within the care setting. The home is run in the best interests of the residents where opportunities exist for them to contribute on a regular basis. Residents’ financial interests are suitably safeguarded. The home ensures that there are sufficient numbers of staff on duty at all times to meet the needs of the residents. The staff team collectively have a range of experience to meet the needs of the residents. Those residents who commented spoke very positively about the care provided by the staff, stating that they are very well cared for. The two relatives spoken to and the three comment cards also received from residents’ relatives endorsed these comments. Other comments made by residents’ relatives included that the residents are treated very well by staff, who are kind and friendly. Residents’ relatives also confirmed that they are welcome at the home at any time, they can see their relatives in private, there are always sufficient members of staff on duty and they are satisfied with the overall care provided. Two of the three comment cards and two relatives spoken to during the inspection also stated that they are kept informed of important matters affecting their relatives although the third comment card stated that they had not been informed of an incident at the time it happened, although they were satisfied with the outcome. Staff were observed to carry out their duties in a caring and attentive manner where relaxed, warm and positive relationships appear to exist between the staff and residents. What has improved since the last inspection? The home continues to make significant improvements with regard to the administration processes and changes to the practice of care provided to the residents. Alpine Villa DS0000028251.V299009.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Alpine Villa DS0000028251.V299009.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Alpine Villa DS0000028251.V299009.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 5 and 6 This judgement has been made from evidence gathered both during and before the visit to this service. Residents are provided with a copy of the home’s written contract and have been fully assessed by the home, prior to admission, to ensure that their needs can be met. Opportunities are available for prospective residents and their families to visit the home, prior to admission, to assess the quality of facilities and suitability of the home. Quality in this outcome area is good. EVIDENCE: Since the last random inspection, the home has reviewed and amended its statement of purpose/service users’ guide to ensure that the document contains all the relevant information. However, the statement of purpose/service users’ guide still needs to include a statement regarding fire precautions and associated emergency procedures and arrangements made for dealing with reviews of the service users’ plans. The deputy manager will ensure that all residents’ relatives or appointees, where no family member exists, will be provided with a copy of the revised document. Alpine Villa DS0000028251.V299009.R01.S.doc Version 5.2 Page 10 All residents would normally be provided with a copy of the home’s contract unless funded by social services. In these circumstances residents would be provided with a copy of the placing authority’s terms and conditions. Evidence was available to confirm that the recent resident admitted had signed the home’s contract. Evidence was available to confirm that contracts had been established for other residents previously admitted apart from one. The deputy manager has agreed to send another copy to the resident’s family to sign and return. Only one resident has been admitted to the home since the last inspection and written evidence was available to confirm that the home had completed its own assessment tool in relation to the resident, at her home and in consultation with her and her husband. The home would also obtain a copy of the person’s most recent community care assessment or the equivalent for those prospective residents funded by Social Services. As part of the admission process, prospective residents and their families are encouraged to visit the home, prior to admission, to assess the quality of facilities and suitability of the home. However, the most recent resident admitted chose not to make any pre-visits. The home does not provide intermediate care, therefore, this Standard is not applicable. Alpine Villa DS0000028251.V299009.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 This judgement has been made from evidence gathered both during and before the visit to this service. Suitable care plans have been established for all residents and their health care needs are being suitably met. Residents are not deemed capable of maintaining control for their medicines, although suitable procedures have been established for dealing with residents’ medication. Residents’ rights to privacy is respected. Quality in this outcome area is good. EVIDENCE: Detailed care plans have been established for all residents which are informative and are supplemented by a daily routine information sheet that covers their preferences regarding their daily routines, personal care food/mealtimes, hobbies and interests. Written evidence was available to confirm that residents’ care plans are being reviewed monthly. Individual risk assessments have also been established for residents and again evidence was available that these are also being reviewed. The deputy manager was advised of ways of developing the content of these. Written evidence was available to confirm that some residents, particularly social services clients are being reviewed. However, the deputy manager has agreed to ensure that all residents’ placements are suitably reviewed and involves all relevant parties. Alpine Villa DS0000028251.V299009.R01.S.doc Version 5.2 Page 12 This will be achieved initially after four weeks, then six months and thereafter yearly unless their particular circumstances change. In addition residents’ files will be departmentalised for easier reference. Residents admitted to the home are registered with one of two surgeries. Residents who are able are encouraged to attend the surgeries for any appointments with the assistance of staff or their families. However, where this is 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 residents’ bedrooms. District nurses records are kept within residents’ bedrooms and written evidence was also available in the home’s records to confirm visits and treatment by health professionals. However, the deputy manager has agreed to develop a separate form for all medical appointments/treatment for easier monitoring. Domiciliary visits are made to the home, for the benefit of the residents, in respect to dental care, opticians and chiropody. The home has established a medication policy. None of the residents are deemed capable of being responsible for the administration of their own medication. Therefore, all medication is administered to residents by staff who have completed the ‘Safe Handling of Medicines’ course or who have been deemed competent by the management of the home. The deputy manager reported that six staff have completed the ‘Safe Handling of Medicines’ course and others will also undertake the same training once they have completed their NVQ training. The home uses the monitored dosage system and examination of the medication sheets showed that they are being suitably initialled for medication received, administered and returned. The visiting pharmacist visited the home on 17th June 2006 to check the storage, receipt, administration and disposal of medication as well as to undertake a review of residents’ medication. A copy of the pharmacist’s report has been sent to the Commission which identifies some areas which require improvement, such as storage of medication, the return of unwanted medicines and use of specified liquids and eye drops. These issues will be checked at the next pharmacist’s inspection in October 2006. Comments are contained within the home’s statement of purpose/service users’ guide which confirms the core values of good practice such as privacy, dignity, choice, independency and fulfilment. The aim of the home is to strive to retain as much privacy as possible for residents. The issue of respecting residents’ privacy is covered during staff induction. Observations and discussions with management and residents confirmed that residents can choose where to spend their time and who and where to see any visitors. Residents have access to three phones, one of which is a cordless, from which they can make and receive calls in complete privacy. Residents who are capable deal with their own mail. However, the proprietor deals with the vast majority of residents’ official mail with staff assisting residents to understand the contents of any cards and other letters addressed to them. Locks have Alpine Villa DS0000028251.V299009.R01.S.doc Version 5.2 Page 13 been fitted to the toilets and bathrooms and due to the toilet, which is located by the main lounge/dining room, being enlarged, residents’ privacy is now fully maintained with the door being kept closed when being used. Alpine Villa DS0000028251.V299009.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 This judgement has been made from evidence gathered both during and before the visit to this service. Residents’ social, recreational, and spiritual needs are suitably catered for. Residents maintain contact with their families and friends in accordance with their individual circumstances. Residents, within their capabilities, can exercise personal autonomy and choice. Residents receive a varied and balanced diet with meals being taken in a congenial and relaxed setting. Quality in this outcome area is good. EVIDENCE: Observations and discussions with management confirmed that residents, within their capacity, can choose where and how to spend their time. Residents have the opportunity to pursue their own individual interests, which include attending various community based activities, as well as being able to participate in the various organised activities arranged by the home. Activities were taking place during the course of the inspection and residents were suitably supported in these where they required it. Some residents were observed to opt in and out as they wished. Residents were observed assisting with the routines of the home such as dusting and hanging out the washing through choice. Residents’ daily care plan notes also confirm activities attended both within and outside the home. The vast majority of residents require accompanying by their families, proprietor or staff when out and residents are taken out to the shops or for a walk in the local park. A church Alpine Villa DS0000028251.V299009.R01.S.doc Version 5.2 Page 15 service is held within the home every few months or residents can attend services at the local church. A hairdresser visits the home on a regular basis for those who wish to use the facility. The home has no restrictions with regard to visiting times and this is confirmed within the home’s statement of purpose/service users’ guide. Observations and residents’ records confirm that residents receive visits from their families and friends and the frequency of contact is very much dependant on their individual circumstances. Some residents are taken out by their relatives and friends. Evidence was available to confirm that residents can see their visitors either in the privacy of their bedrooms in the lounge areas available. Observations and discussions with residents and management confirmed that residents, depending on their capabilities, can exercise personal autonomy and choice in a number of ways. This is also referred to in the home’s statement of purpose/service users’ guide. Residents can bring items of furniture and personal possessions to make their bedrooms more homely, they can make their own drinks, choose where to spend their time, where to eat, and what activities to participate in. Staff support is provided to those residents who need help in choosing what clothes to wear. One resident handles his own finances. Residents’ preferences regarding their daily routines have now been incorporated into their care plans. A satisfactory and varied menu is in operation which confirms that residents are provided with a choice for breakfast and teatime with a set main meal at lunchtime. However, written evidence was available to confirm that alternatives are provided to meet the preferences and dietary needs of residents and any changes are suitably recorded. Residents tend to use one of the two dining rooms to eat their meals. Observations of the main meal eaten, in the main dining room, confirmed that considerate and supportive assistance was given to those residents who needed help with the eating of their meal. The meal was eaten in a pleasant and relaxed atmosphere where residents were not rushed. Residents who commented about the quality and quantity of food provided stated that the food was adequate to good. Alpine Villa DS0000028251.V299009.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 This judgement has been made from evidence gathered both during and before the visit to this service. Residents are provided with appropriate information on how to complain and they felt confident that any complaints would be listened to and acted upon. Appropriate procedures have been established to protect the residents from abuse and staff are aware of these. Quality in this outcome area is good. EVIDENCE: The home has established a complaints procedure and a copy of this procedure is displayed on the notice board in the hallway of the home. A further copy is also contained within the home’s statement of purpose/service users’ guide. Due to the residents’ capacity, agreement has been reached to ensure that residents’ relatives are provided with a copy of the home’s revised statement of purpose/service users’ guide. A copy of the procedure also needs to be given to those residents with mental health problems. The home and the Commission have not received any complaints since the last inspection. Residents spoken to expressed no complaints/concerns. The home has established its own policy and procedure in relation to 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 spoken to confirmed that they have been provided with a copy of this document. Staff within the home could benefit from receiving training in this area. Alpine Villa DS0000028251.V299009.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 23, 24, 25, 26 This judgement has been made from evidence gathered both during and before the visit to this service. The location and layout of the home is suitable for its stated purpose. All parts of the home are accessible, safe and suitably maintained to meet the residents’ individual and collective needs and provides sufficient communal facilities. The home continues to be maintained to a reasonable standard being clean, tidy, comfortable, suitably furnished and decorated, although there are some areas which require improvement. The home provides a sufficient number of toilets and bathrooms. Residents’ bedrooms are suitable to meet their needs and residents have personalised them to their individual wishes. The home provides appropriate laundry facilities to meet the needs of the residents. Quality in this outcome area is good. EVIDENCE: The premises continue to be maintained to a reasonable standard and offers suitable heating lighting and ventilation. The standard of decoration within the home varies, although the majority of it is maintained to a good standard. A tour of the premises identified a few areas which require improvement to Alpine Villa DS0000028251.V299009.R01.S.doc Version 5.2 Page 18 ensure that the home is maintained to a suitable standard and these were discussed with the deputy manager. These include the re-decoration of two bedrooms, the water outlet to the hot water taps to some residents’ bedroom sinks is cold and needs attention and the bedroom door to one bedroom requires adjustment to ensure that it shuts on its rebates. The home provides 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 are suitably furnished and decorated. The home also provides a small, enclosed rear garden which is used by some residents, particularly those who smoke. The home provides a sufficient number of bath, shower and toilet facilities, which are located within close proximity to residents’ bedrooms and the communal rooms. The toilet strategically located close to the main lounge/dining room on the ground floor has been enlarged to provide more appropriate facilities to meet the needs of the residents. It was also suggested that the two very small toilets located on the first floor could also benefit from being converted into one at some point in the future. The home provides nine single bedrooms two of which are provided with ensuite facilities and three shared bedrooms. Residents’ bedrooms are located on the ground and first floor levels which are accessed by use of a staircase. All rooms are fitted with a call bell system which residents can use to summon staff assistance if required. However, some of the cords are not suitably located by residents’ beds, although it was acknowledged that some residents would not necessarily know their purpose. Residents’ bedrooms are adequately furnished and decorated to varying degrees although it was previously reported that residents’ bedrooms are normally redecorated and re-carpeted when there is a change of occupation. Residents can and some have brought items of personal possessions to make them more homely with residents having personalised their bedrooms to their individual wishes. The deputy manager was advised that this is an area that could be improved with the support of staff. Residents spoken to commented positively about the standard and cleanliness of their accommodation. The home continues to be maintained to a reasonable standard, being clean and tidy. However, there was a distinct odour to two of the bedrooms which needs attention. The laundry room is located on the ground floor and provides adequate facilities to meet the needs of the home. Residents’ clothing is labelled to ensure that garments are appropriately returned and care staff, with some input from the waking night staff, undertake this task. Residents, who commented, spoke favourably about the laundry arrangements in place. Alpine Villa DS0000028251.V299009.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 This judgement has been made from evidence gathered both during and before the visit to this service. The home ensures that there are sufficient numbers of staff on duty at all times to meet the needs of the residents. The staff team collectively have a range of experience to meet the needs of the residents and the home is working towards achieving a trained workforce, which includes staff completing NVQ as well as specialist training. The recruitment practices within the home require further improvement to ensure the protection of residents. Quality in this outcome area is adequate. EVIDENCE: Examination of the staff rotas showed that the home continues to provide two members of care staff on duty throughout the waking day with one member of waking night staff on duty and one member of care staff sleeping in each night. However, there were a few occasions where the member of waking night staff or the member of care staff was not clearly identified on the rota. The home has recently employed a cleaner who works three days a week. Discussion was held about employing a cook/cleaner or a third member of care staff, particularly in the mornings. However, the current staffing levels provide a good ratio for the numbers of residents accommodated at the time of the inspection. However, management are aware of the need to increase the staffing levels throughout the waking day should the number of residents exceed ten. Those residents who commented spoke very positively about the care provided by the staff, stating that they are very well cared for. The two relatives Alpine Villa DS0000028251.V299009.R01.S.doc Version 5.2 Page 20 spoken to and the three comment cards also received from residents’ relatives endorsed these comments. Other comments made by residents’ relatives included that the residents are treated very well by staff, who are kind and friendly. Residents’ relatives also confirmed that they are welcome at the home at any time, they can see their relatives in private, there are always sufficient members of staff on duty and they are satisfied with the overall care provided. Two of the three comment cards and two relatives spoken to during the inspection also stated that they are kept informed of important matters affecting their relatives although the third comment card stated that they had not been informed of an incident at the time it happened, although they were satisfied with the outcome. Staff were observed to carry out their duties in a caring and attentive manner where relaxed, warm and positive relationships appear to exist between the staff and residents. The staff team have a variety of experience in the care profession and the home continues to work towards achieving at least 50 of the staff team being trained at NVQ level 2 in care. Currently only three out of thirteen members of care staff have achieved NVQ 2 and/or 3 with a further five members of staff undertaking NVQ 2 and one completing NVQ 3. Since the last inspection the home has employed one member of staff and examination of her file showed that all satisfactory checks had been carried out which included two references, a CRB check and medical clearance. However the deputy manager was advised of the need try and obtain dates for the person’s employment history and check for any gaps within it. The home has established an induction programme, which is completed by all new staff employed. The home uses the Basic Assessment Training and Proficiency Record ‘Direct Care’ booklet for this purpose, which is an ongoing tool. Individual training records have been established for all staff and these show that staff have received various amounts of mandatory and specialist training. The deputy manager was advised of the need for staff to receive health and safety and infection control training. Some staff have received dementia training. Alpine Villa DS0000028251.V299009.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 35, 36 and 38 This judgement has been made from evidence gathered both during and before the visit to this service. The home is run and managed by persons who are appropriately qualified and have sufficient experience within the care setting. The home is run in the best interests of the residents where opportunities exist for them to contribute on a regular basis. Residents’ financial interests are suitably safeguarded. Staff supervision is still an area of some deficiency. The health, safety and welfare of the residents and staff are promoted and protected, apart from the area of fire prevention and the receipt of all mandatory training. Quality in this outcome area is adequate. EVIDENCE: The proprietor/manager has considerable years experience in both management and in a supervisory role in the relevant care setting she manages. She has a SEN(M) qualification and has almost completed the Registered Managers’ Award. The proprietor/manager is supported in the day Alpine Villa DS0000028251.V299009.R01.S.doc Version 5.2 Page 22 to day management of the home by her deputy manager who is due to commence the Registered Managers’ Award in August 2006 and also intends undertaking the Assessors’ Award in September 2006. The deputy manager has increasingly taken over all aspects of the day to day management of the home and will eventually apply to be the registered manager. Discussions with staff indicate that residents benefit from an open and positive atmosphere within the home where the proprietor/manager and deputy manager communicate with a clear sense of direction and leadership. Staff acknowledged that changes in practice and to the care of the residents have been implemented and these have been viewed as a positive step forwards. Staff morale appears good and staff commented that they work well as a team and management are very approachable and they can discuss any issues with them. Staff also stated that they are happy with the care provided to residents and they have received positive feedback from the residents’ relatives. The home continues to maintain a record of personal expenses for money spent with regard to some residents and their relatives are subsequently invoiced for this. One resident manages his own money and their appointees manage other residents’ monies. Evidence was available to show that formal and recorded supervision has only been provided to the majority of staff since February 2006. However, staff tend to receive supervision on a more informal basis and staff confirmed this. The deputy manager acknowledged that the frequency of formal supervision needs to be increased, the content of recording of supervision needs to be in more depth and she could benefit from undertaking a supervision skills course. The frequency of formal staff meetings/training sessions could also benefit from being provided on a more regular basis as the last one was held in December 2005. A copy of the Health and Safety Act is on display within the home, although it was acknowledged that the deputy manager could benefit from undertaking a course in health and safety, which also focuses on risk assessments. As stated previously in the report, the home needs to ensure that all staff receive the required mandatory training. No particular health and safety issues were apparent from a tour of the premises, although it was noticed that one fire door to one of the resident’s bedrooms needs adjusting to ensure that it fully shuts on its rebates. Three accidents to residents have occurred since the last unannounced random inspection held on 2nd May 2006. These have been suitably recorded in the accident book and cross-referenced within the residents’ daily care plan notes. However, the proprietor/manager was informed of the need to provide the Commission with notification of any death, illness and other events relating to residents by way of Regulation 37 Notices and these should be completed in sufficient detail. Examination of the fire log book showed that the date needs to be recorded denoting when staff are provided with fire instruction and fire drills need to be carried out on a Alpine Villa DS0000028251.V299009.R01.S.doc Version 5.2 Page 23 quarterly basis. maintained. Otherwise all other checks and tests are being suitably Alpine Villa DS0000028251.V299009.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 3 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 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 2 3 3 X 3 3 3 3 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 3 X X 3 2 X 2 Alpine Villa DS0000028251.V299009.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4 and 5 Timescale for action The registered individual must 30/09/06 ensure that the home’s statement of purpose/service users’ guide meets all the relevant information and a copy of the revised document is provided to the Commission and all residents’ relatives or appointees. The registered individual must 31/12/06 establish a review system for all residents’ placements in line with the home’s procedures and to invite all relevant parties to the reviews, where applicable. The registered individual must 07/08/06 ensure that the water outlet to the hot water taps to some residents’ bedroom sinks is adjusted. And the bedroom door to one bedroom requires adjustment to ensure that it shuts on its rebates. The registered individual must 07/08/06 ensure that the door to one bedroom is adjusted to fully shut on its rebates. The registered individual must 30/09/06 ensure that a full employment DS0000028251.V299009.R01.S.doc Version 5.2 Page 26 Requirement 2. OP7 15(2)(b) 3. OP19 16(2)(f) 4. OP19 23(4)(a) 5. OP29 19(1)(b) Alpine Villa 6. OP36 18(2) 7. OP38 17(2) 8. OP38 37(1) 9. OP38 18(1)© history is obtained in respect to all new staff employed, which clearly shows all dates of previous employment. Previous timescale of 30/06/06 was not met and a new timescale to ensure compliance has been set. The registered individual must ensure that all staff receive regular supervision and the level of content of recording of supervision is recorded in more detail. The registered individual must ensure that the date is recorded denoting when staff are provided with fire instruction and fire drills are carried out on a quarterly basis. The registered individual 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 registered individual must ensure that all staff receive the required mandatory training. 31/12/06 30/09/06 30/09/06 31/03/07 Alpine Villa DS0000028251.V299009.R01.S.doc Version 5.2 Page 27 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 OP36 OP38 Good Practice Recommendations The registered individual should strongly consider developing the content of residents’ risk assessments. The registered individual should strongly consider ensuring that the deputy manager undertakes a supervision skills course. The registered individual should strongly consider ensuring that the deputy manager undertakes a health and safety course which includes risk assessments. Alpine Villa DS0000028251.V299009.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Alpine Villa DS0000028251.V299009.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!