Inspection on 11/03/08 for Ascot Lodge Nursing Home

This inspection was carried out on 11th March 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Ascot Lodge Nursing Home 06/03/07

Ascot Lodge Nursing Home 10/04/06

Ascot Lodge Nursing Home 01/11/05

Ascot Lodge Nursing Home 05/07/05

Ascot Lodge Nursing Home 08/09/04

Ascot Lodge Nursing Home 09/06/04

Ascot Lodge Nursing Home 18/02/04

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

CARE HOMES FOR OLDER PEOPLE Ascot Lodge Nursing Home 48a Newlands Road Intake Sheffield South Yorkshire S12 2FZ Lead Inspector Marina Warwicker Key Unannounced Inspection 11th and 13th March 2008 08:20 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 DS0000021765.V358280.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. DS0000021765.V358280.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ascot Lodge Nursing Home Address 48a Newlands Road Intake Sheffield South Yorkshire S12 2FZ 0114 264 3887 0114 264 3969 ascotlodge@schealthcare.co.uk www.schealthcare.co.uk Southern Cross Healthcare Services Limited 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) ** Post Vacant *** Care Home 50 Category(ies) of Dementia - over 65 years of age (50) registration, with number of places DS0000021765.V358280.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Care Home with Nursing Dementia over 60 years. Date of last inspection 6th March 2007 Brief Description of the Service: Ascot Lodge is a purpose built fifty-bedded home providing service for older people with dementia. The home is situated in the Intake area of Sheffield. It has good access to public services and amenities. The accommodation is on two floors and each floor is divided into two units. Most rooms are single with en-suite facilities. There is a car park to the front. The weekly fees during our site visit were between £418 and £552. The administrator explained that the fees were charged according to the dependency levels of the individuals and also according to source of funding. The people using the service buy their own toiletries and pay for hairdressing and chiropody with their pocket money. DS0000021765.V358280.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that the people who use this service experience adequate quality outcomes. An inspection of this care home was carried out on Tuesday 11th March 2008 between 8.30 am and 3 pm. A second visit took place on Thursday 13th between 1.30 pm and 3.30 pm. The staff, the management and the people using the service were not informed of our first visit and therefore it was unexpected. However, the second visit was arranged with the management to complete the paperwork. Three people using the service were consulted, eleven people using the service were observed, four relatives and ten staff were spoken with. A further ten relatives and four professionals who came into contact with the people were contacted by post and telephone to obtain their feedback about the service. Comments received from the surveys have been included in the body of the report. Any comments received after the publication of this report will be shared with the management of the home. Time was spent observing and chatting with people using the service, the staff, the management and the visitors. The manager was on holiday and a manager from another Southern Cross care home arrived to give support to the deputy manager and assisted us with the site visit. The operations manager and the responsible individual joined us during the latter part of the inspection and were present at the final feedback. The premise was inspected, which included bedrooms of the people using the service, the communal areas and the service areas such as the kitchen and the laundry. The outside areas surrounding the building were also checked. Forty nine people were using the service on the day of the site visit. Samples of individuals’ care plans, staff recruitment and training files were some of the records checked. We would like to thank the people who live at Ascot lodge, their relatives, the staff who took part and the management including the visiting manager for the contribution towards this process. DS0000021765.V358280.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? The care staff were observed interacting with the people using the service and making time to sit and chat and make time for the older people. The service user plans had been reviewed and the daily documentation reflected the actual care given. There were clear instructions for identified needs. Records were maintained by the staff to monitor the care progress made. The activities offered were varied and flexible. The meal times were unhurried and staff were available to offer assistance when necessary. The management investigated complaints made under their complaints procedure and informed the complainant of the outcome within the stated time. The manager maintained records of complaints. All parts of the home were sufficiently heated and the people using the service were comfortable. Management of continence within the home had been reviewed to ensure the units remain free of offensive odour. DS0000021765.V358280.R01.S.doc Version 5.2 Page 7 The relatives /representatives of service users had been kept informed of the outcome of general practitioner visits and hospital appointments. What they could do better: The registered provider must ensure that the home is in receipt of sufficient funding so that the people at the home are able to receive appropriate food at the correct intervals. The catering staff should not be expected to find ways of making up the deficit in the budget in order to provide adequate meals and snacks for the people using the service. The people using the service must have access to drinks and snacks throughout the day. This was a previous requirement and progress has not been made. The management of the home must make suitable arrangements for the disposal of general and clinical waste to avoid health & safety hazards. All parts of the home must be free from offensive odour. The action taken must also include eliminating the unpleasant odour emitted from the hair dressing room. The management must ensure that at all times there are sufficient numbers of staff employed to promote the health safety and welfare of those living and working at the home. The staff rotas must be completed in advance to ensure sufficient staff have been allocated for the shifts. The management must ensure that they take reasonable actions to protect the people using the service and the staff working at the home by: Taking prompt action when staff receive bruises from people using the service. Ensuring two staff are allocated to units to avoid one member of staff having to move & handle people using hoists. The care staff should not be allowed to commence work on the units before receiving handover for their shifts. Therefore being aware of the changes during the previous shift. Appointing a co-ordinator in the absence of the manager during the day to carry out the day to day running of the home. The staff on the units should be aware of those service users who use spectacles and they should ensure that the service users are encouraged to use them. Social, cultural and recreational activities were offered. However, there was little evidence that the individual’s expectations, preferences and capabilities had been considered when organising activities. There should be records of DS0000021765.V358280.R01.S.doc Version 5.2 Page 8 activities and the involvement of each resident to ensure all the people using the service are offered opportunities. The management approach must create a positive and inclusive atmosphere so that the staff are encouraged to be creative, innovative and take ownership of their best practices. The care staff must feel part of the team. The complaint procedure should ensure that following complaints, the complainants are confident that the action taken by the management would help the other people. The staff meetings should be used to include staff ideas and listen and discuss matters involving the running of the home. 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. DS0000021765.V358280.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 DS0000021765.V358280.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): 3, 4 and 5. People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. People who may wish to use the service; their representatives and the funding authorities are assured by the management of Ascot Lodge Care Centre that they are able to meet the needs of the individuals. EVIDENCE: Four care plans were checked, five staff were interviewed, the management on duty were consulted and the relatives’ comments had been taken on board. The people using the service have had their needs assessed by the placing authorities and the home had carried out its own assessments and agreed to deliver the appropriate care for the people. The staff working at the home had helped some of the relatives by offering them the opportunity to look around the home to find out the facilities and to decide on the suitability of the home. One person said, “The staff were very positive and encouraging when I came to look around. There was no pressure.” One of the staff said, “I know the families don’t like putting their loved ones in DS0000021765.V358280.R01.S.doc Version 5.2 Page 11 a home. I always tell them that we don’t treat them any different to any older person just because they have dementia”. Other comments confirmed that the home allows trial periods for new admissions to help the person settle and find out their suitability to live with the others at the home. DS0000021765.V358280.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 and 10. People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. The health and personal care that people receive is based on individuals’ needs. The principles of respect, dignity and privacy are put into practice by the staff and the management. The individuals and their representatives are sometimes involved in decisions and they are able to have an active role in planning the care they receive. However, this practice is not common within all four units of the home. EVIDENCE: On the days of the site visit, we observed the care delivered by staff with peoples’ consent; we spoke with the people using the service, their relatives and the staff on duty. We also carried out SOFI (short observational framework for inspection) to focus on the quality of care provided in the care home for older people with dementia, particularly in relation to dignity and peoples experiences. DS0000021765.V358280.R01.S.doc Version 5.2 Page 13 In one area we observed five people, they were in a positive emotional state. This was demonstrated by one of the people singing, another was looking happy and smiling and the other three were humming and encouraging the person to go on singing. Two care staff joined in later during our observation. The staff engagement had a positive effect on the people. In another area two people were seen to be in a passive state. They were awake and watching what was happening around them but they did not actively participate. One of the staff was seated away from the two people we were observing and was chatting to another person in the room. There was a calm atmosphere experienced by us. We also observed four people in another lounge. They were asleep during the time we were carrying out our observation. Although one staff entered the room from time to time to check on the people, the four people slept through. The above observations confirmed that people were comfortable, relaxed after lunch and were enjoying the rest. The general mood was calm and the staff were interacting with the people and joined in activities. We checked the care plans to see whether the care given was documented in the care plans and whether these were appropriate. This was fully explored during the second visit. We found that there were some gaps and duplications in the documentation and this was discussed with the deputy manager. For example, record of the bath water temperature was not noted on the care plan where this information was requested but the deputy manager said that this information was kept in the bathrooms by the staff. There were other examples we highlighted on the day and the deputy manager assured that the information was available and that they were kept in different places. Most of the people were seated in the lounges and some were walking around the unit and some were bed bound due to their condition. Although it was customary for staff to record pressure relieving turns for people who were bed bound and maintain food and fluid intake charts this practice varied from unit to unit. The staff said that none of the people using the service had pressure sores and we witnessed staff easing positions of those who were unable to mobilise. In one of the units we found a person sitting on the sling used by staff to hoist. We informed the nurse in charge and the sling was removed immediately. Such slings are used for transportation only and can cause discomfort if left on. We observed the nurses administering medication to the people using the service. We noted the nurses made sure that the people had taken the medicine before moving on to the next person. Due to the nature of the people occupying the home this task took a considerable amount of time during each shift. We checked four medicine administration records and they were satisfactory. The supplying pharmacist had carried out an audit and highlighted DS0000021765.V358280.R01.S.doc Version 5.2 Page 14 some gaps in the practices and the deputy manager explained that they were taking action to rectify these. She informed us of the action taken by them to improve the medication management systems at the home. The deputy manager also informed us that none of the present residents were able to self medicate. The people using the service were treated with respect and the staff upheld their privacy when entering their bedrooms and delivering personal care. We saw people wearing their own clothes and the clothing looked clean. The staff addressed the people by their preferred names. We saw such details when we checked the care plans. DS0000021765.V358280.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. People who use services are in the main able to make choices about their life style, and the staff at the home supported them to maintain their life skills. Social, cultural and recreational activities are offered. However there was little evidence that the individual’s expectations, preferences and capabilities had been considered when organising activities. The catering budget is insufficient to provide people living at the home with suitable meals. EVIDENCE: On the first day of the site visit an activities co-ordinator was on duty and he was enthusiastic. He was seen engaged in small group activities with the people using the service. We had an opportunity to discuss his plans for the next few months. We discussed the usefulness of having access to the information on individuals’ interests, preferences and capacity so that each person could have opportunities for stimulation through activities in and outside the home. People using the service had visitors during our site visits and the staff made them welcome. The visitors confirmed this to us when we spoke with them. DS0000021765.V358280.R01.S.doc Version 5.2 Page 16 Some people had personal possessions in their bedrooms. The corridors had been decorated and seating facilities provided so that people were able to reminisce and sit around. The following were some of the findings with regards to meals and mealtimes. It was agreed by the responsible individual as a result of our last inspection site visit that there would be trolleys of snacks and drinks on each of the four units throughout the day, so that the staff are able to offer people snacks and drinks. We did not notice this. When we made further inquiries the staff were confused and did not know about the agreements. But they said some get special drinks between meal times. Later on the cook explained that normally some people had smoothies in the midmorning and the others were offered in the afternoon. But due to the delay in the food delivery the people did not receive smoothies on the day of our visit. The staff commented that the kitchen was too far from the first floor and that there wasn’t enough staff on duty for them to be able to leave the units and go down to the kitchen to make a hot drink for the people using the service. We witnessed the staff assisting people when they were having their breakfast and again at dinner. Three people commented positively about the lunch they had on the first day of our visit. One person said, “I enjoyed my dinner and today’s pudding. It was lovely.” We received the following information with regards to catering at the home. The catering budget was insufficient and that the kitchen staff had to resort to selling the left over food to care staff working at the home so that they could buy snacks for the people using the service. The insufficient budget did not lend itself for the people having a varied diet. Food delivery did not coincide with the requirement of the home. Therefore there were days when people could not have much choice including fruit, drinks and smoothies. The management including the responsible individual were informed of the above findings. DS0000021765.V358280.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17 and 18. People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. People who use the service are able to express their concerns and have access to a complaints procedure. Not all complainants are satisfied with the way complaint investigations are handled by the management. The people using the service are protected from abuse and have their rights protected, by the staff awareness and training. EVIDENCE: There was a clear complaints policy which people were able to access when they entered the home. The staff commented that they followed the procedure which included any concerns or complaints reported to the nurse in charge of the unit even if they felt they had remedied the concerns. We received the following comments from relatives. One said, despite letting the staff know that they were going away and letting the management have the contact details the staff did not inform the relatives of a serious incident and they had to find this out on their return. Another informed us that their relatives had not been informed of a death of a person at the service. This was due to the management not being aware of the details of the person’s representatives. (These comments have been addressed under management.) And another person informed us that the staff had a difficult job to do since the people could be unpredictable and accidents did happen and the staff at the home had kept them informed. DS0000021765.V358280.R01.S.doc Version 5.2 Page 18 On the days of our visits there were two relatives who made positive comments about the liaisons between the staff and themselves, which was encouraging. One said that the staff called them anytime of day to keep them informed of any incidents. All allegations of abuse or neglect of people using the service had been promptly reported to the appropriate authorities and the manager had taken the necessary action. The manager had maintained records of such investigations. The staff had attended training on safeguarding adults. During our conversation two staff were able to explain the correct procedure for reporting any abuse if they were to witness any. DS0000021765.V358280.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24 and 26. People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. The physical design and layout of the home enables people who use the service to live in a safe and comfortable environment, which encourages independence. However, some areas of practice did not comply with the health & safety and Infection control standards therefore putting people living and working at the home at risk. EVIDENCE: On the first day of our site visit as we entered the car park we found several yellow bags (20 ) of clinical waste thrown by the side of the already full bins. One bag was split and the contents were exposed causing a health & safety hazard. There were also some full domestic waste bags (black bags) placed next to the domestic waste bins, which were also full. Later in the morning the manager who was assisting us with the site visit explained that the staff at the home DS0000021765.V358280.R01.S.doc Version 5.2 Page 20 have had trouble getting the waste removed by the contractors. But all bags were removed later that day. As we approached the front entrance of the home on the first day there was an unpleasant smell, which was similar to stale urine. As we got inside the lobby it was very stuffy and unpleasant. We observed the doorbell case was broken. This was mended and relocated on our second visit on Thursday 13th March. During the tour of the premise we saw old food splashes on one of the lounge ceilings. In the same lounge there were three sets of spectacles put aside on the TV stand. The TV screen was dusty and dirty, and the ornamental fire surrounding was in need of cleaning and repainting. Some lounge chairs needed cleaning as they had been stained. The management witnessed this. On the first floor there was a strong smell of ‘drain’. We were informed that it could be the smell from the hair dressing room. We noted that sets of mattresses were stored against the wall of a staircase. Some of the rooms were individualised and reflected the people’s personalities. There was a laundry, which was kept locked so that the people using the service could not wonder into it and harm them. DS0000021765.V358280.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. The staff receive training to maintain the necessary skills. The number of staff allocated on each shift to support the people needs to be reviewed to reflect the size, the layout and the dependency levels of those occupying the home. EVIDENCE: On the first day of our site visit we were informed that there were forty nine people residing at the home. The home is divided into four units. There were two nurses, eight care assistants, an activities co-ordinator, a maintenance person, an administrator, three domestic staff and two kitchen staff on duty. There was plenty of staff around. The atmosphere in the two smaller units was much calmer and the people using the service had more contact with staff than the other two larger units. Through our observation we deduced that this was due to the number of care staff allocated to each unit and the dependency levels of the people occupying the units. DS0000021765.V358280.R01.S.doc Version 5.2 Page 22 On the day of the site visit the manager was on leave and the deputy manager was working as the nurse for the floors. We were informed that usually there were two nurses and the manager on duty during the day. The nurses’ duties included organising the care staff and ensuring delivery of care according to the care plans during their shift, administration of medication, liaising with GP and other professionals and also supervising the care staff working within the floor. On the day of our visit the home was without an overall manager/ coordinator. Therefore a manager from another home was invited to assist at the inspection site visit so that the deputy manager was able to carry on with her duties as the nurse on duty on the floor. The management said that they were one care assistant and a kitchen staff short and they were recruiting for these positions. We informed the management that the deputy manager’s role should be to act up in the absence of the manager of the home and therefore two nurses should be allocated to cover the shift. The staff were concerned that often to cover staff shortage the small units were left with one care staff. This made it difficult when they had to hoist people in and out of bed and chairs. The staff survey indicated that they did not feel safe when left alone on the unit and they had to ask the nurse to help with the activities. The management were made aware of this comment. One the first day of our visit we found that the staff rota was only completed up to that weekend. It is useful for the staff to know when they were working and able to organise their life outside the workplace. Three staff surveys commented about the rotas not being available in advance. The staff were asked to take annual leave and then rung by management to see whether they could work. The management said that to maintain continuity of care they ask the staff whether they wanted to cover shifts and avoid using agency staff. In order for the people using the service to be in safe hands, the staff need to have up to date information about the people they were to look after at the beginning of each shift. This needs to be achieved by an effective handover between staff at the beginning of each shift. The deputy manager said that the nurses received hand over and then they organised the care staff on each unit. She said that they retained a handover sheet where the previous shift manager had recorded changes. The comments we received from staff highlighted the gaps in this arrangement. We ascertained from the information we gathered that the staff arrived on duty and they took over and continued the care until the nurse DS0000021765.V358280.R01.S.doc Version 5.2 Page 23 came to inform them of changes. There wasn’t any formal staff handover between shifts. We understood that the nurses instructed the care staff during each shift. The care staff were allocated tasks they needed to perform and there was a lack of understanding by care staff why they were carrying out certain tasks. During our tour of the home we asked two care staff why a person was nursed in bed and the reason why s/he was not sitting out. The care staff said that they were told by the nurse to get the person out at lunchtime but was not sure why they could not before. We checked four staff recruitment files. The management had operated a thorough recruitment procedure and the individual’s records were appropriately maintained to ensure information was held safely according to data protection act. A training matrix was maintained centrally to audit staff training and the information available to us demonstrated that staff were receiving a mixture of in house and outside training. Staff also said that they had attended service specific training on understanding and caring for people with dementia. DS0000021765.V358280.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36 and 38. People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. The management and administration of the home is based on openness and was accessible to people using the service. They have developed a quality assurance system to monitor the running and the practices at the home so that they are able to measure how they meet the aims and objectives of the service. The communication between the management and the workers needs to improve to promote better working relations, positive team spirit and better understanding of each others roles. DS0000021765.V358280.R01.S.doc Version 5.2 Page 25 EVIDENCE: The day to day operations were managed by the present manager. The manager is a qualified and experienced person who maintains a clear line of accountability within the home and also with any external contacts. The manager and the senior staff at the home continued to update themselves on the conditions and the diseases relating to old age and dementia. Since the last inspection site visit there have been several quality monitoring systems introduced and the management continue to self-monitor and use the results of the surveys to improve the areas they had identified. There had been regular staff meetings and we had access to the minutes of last two meetings. Care staff commented that when they had staff meetings the management used them to tell them where they had gone wrong. There was a lack of positive feedback from the management. The reason for the last meeting was to inform them that the management were expecting a Commission for Social Care Inspection visit at any time. We received the following comments. “Why should we be frightened of your visits? By rushing around and making everything right for your visit we miss the important job, i.e. taking care of these old people.” “Staff meetings are never a two way thing. We are told what we should do and they tell us the changes the company is making.” “It is good we get invited to meetings. This is an improvement and I hope they will start listening to us. The manager tries to be fair.” We deduced from our findings that there was a lack of understanding and appreciation of each others responsibilities within the staff and the management at the home. The administrator said that relatives of most people using the service handled the finances and that personnel from Southern Cross central office handled the ones who needed advocates. Two relatives we spoke with confirmed that they looked after the finances and gave the necessary amounts to the administrator or the staff and received receipts. Records were observed on the staff files of their supervision. Three staff said that they received regular supervision. The management said that they did not employ volunteers. We were informed that all new staff received induction and foundation training. Two staff confirmed this and one made a positive comment. ”I have worked in other places and the induction training I received here is one of the best and most useful.” DS0000021765.V358280.R01.S.doc Version 5.2 Page 26 The management informed us that all incidents and injuries to people using the service and the people working at the home were recorded and reported to the central office where these were analysed and reported to ascertain whether there were any trends. We were also told that the copies of the incident records were kept in the individual’s files. Since we did not have access to the outcome of the central audits it was difficult for us assess the risks to people. However, we witnessed a care staff who had been attacked by a person using the service where the staff had sustained large areas of bruising to the arm and nail marks to the skin. The staff said that the management requested an accident form to be filled in and to be handed to the person in charge. When we checked the records we found out that the management had taken no action. We instructed the management to refer the staff to their general practitioner and also find out why this had happened and put in systems to protect the staff from harm. Although the health safety and welfare of the people using the service and the staff were generally protected, certain findings discussed throughout the body of the report needed to be addressed, rectified and monitored by the management. DS0000021765.V358280.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 3 3 N/A 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 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 X X X X 3 X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 2 X 3 3 X 2 DS0000021765.V358280.R01.S.doc Version 5.2 Page 28 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 OP15 Regulation 7 Requirement The registered provider must ensure that the home is in receipt of sufficient funding so that the people at the home are able to received appropriate food at the correct intervals. Immediate 11/03/08. The people using the service must have access to drinks and snacks through out the day. Previous requirement 06/03/07 Immediate 11/03/08. The management of the home must make suitable arrangements for the disposal of general and clinical waste to avoid health & safety hazards. Immediate 11/03/08. All parts of the home must be free from offensive odour. The action taken must also include eliminating the unpleasant odour emitted from the hair dressing room. Previous requirement 27/04/07. Timescale for action 11/03/08 2. OP15 16 11/03/08 3. OP19 16 11/03/08 4. OP26 13,16 02/05/08 DS0000021765.V358280.R01.S.doc Version 5.2 Page 29 5. OP27 18 The management must ensure that at all times there are sufficient numbers of staff employed to promote the health safety and welfare of those living and working at the home. The staff rotas must be completed in advance to ensure sufficient staff have been allocated for the shifts. Previous requirement 06/03/07. 02/05/08 6. OP38 12,13,16& The management must ensure 02/05/08 17, that they take reasonable actions to protect the people using the service and the staff working at the home. The following are some of the instances, which need action. Management not taking prompt action when staff receive bruises from people using the service. Due to shortage of care staff on some occasions one carer is left on the unit where people are having to be moved using the hoists; this puts the staff and the people using the service at risk of injury. The care staff not receiving handover prior to commencing their shifts. Therefore not being aware of the changes during the previous shift. Not appointing a co-ordinator in the absence of the manager during the day to carry on with the management of the home. DS0000021765.V358280.R01.S.doc Version 5.2 Page 30 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 OP12 Good Practice Recommendations The staff on the units should be aware of those people using the service who use spectacles and they should ensure that they are encouraged to use them. There should be records of activities and the involvement of each resident to ensure all the people using the service are offered opportunities. The management approach must create a positive and inclusive atmosphere so that the staff are encouraged to be creative, innovative and take ownership of their best practices. The care staff must feel part of the team. The complaint procedure should ensure that following complaints, the complainants are confident the action taken by the management would help the other people. The staff meetings should be used to include staff ideas and listen and discuss matters involving the running of the home. 2. OP12 3. OP32 4. OP33 DS0000021765.V358280.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI DS0000021765.V358280.R01.S.doc Version 5.2 Page 32 - 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. 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