Inspection on 29/11/07 for Ashbourne Residential Home

This inspection was carried out on 29th November 2007.

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

Other inspections for this house

Ashbourne Residential Home 18/06/07

Ashbourne Residential Home 24/07/06

Ashbourne Residential Home 11/10/05

Ashbourne Residential Home 20/04/05

Ashbourne Residential Home 20/01/05

Ashbourne Residential Home 12/07/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Ashbourne Residential Home Lightwood Road Dudley West Midlands DY1 2RS Lead Inspector Mrs Cathy Moore Key Unannounced Inspection 29th November 2007 06:55 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 DS0000024969.V351675.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. DS0000024969.V351675.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashbourne Residential Home Address Lightwood Road Dudley West Midlands DY1 2RS 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) 01384 242200 01384 231407 www.schealthcare.co.uk Southern Cross Care Centres Limited vacant post Care Home 38 Category(ies) of Dementia - over 65 years of age (12), Old age, registration, with number not falling within any other category (26) of places DS0000024969.V351675.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. That no more than 2 persons who are wheelchair users are accommodated (rooms 30/34) within the additional 10 places. That the additional staffing resources be secured prior to any service user being admitted. One service user in the category of OP may also be A(E). This will remain until such time that the current service users placement is terminated. One service user with sensory impairment elderly SI(E) to be admitted. This wil remain until such time that the current service users placement is terminated. 18th June 2007 Date of last inspection Brief Description of the Service: Ashbourne Care Home is situated off the main Sedgley to Dudley Road. The home is located in a residential area. It is close to a main bus route and a number of small shops. The home has large gardens to the front and rear and a car parking area. The home is registered with the Commission for Social Care Inspection (CSCI) to provide care to Twenty-six residents falling within the category of Old Age and twelve residents who have a diagnosis of dementia. The home has two different sections on the ground floor. One providing care to people who have needs due to old age and a 12 place unit called Malvern which is dedicated to providing care to people who have been diagnosed with dementia, the other provides care to people who have needs relating to old age. The home comprises of two floors. Communal spaces are on the ground floor offering a number of different lounges and a dining room. The ground floor houses the reception area, a number of bedrooms, bathing facilities, the main office, the kitchen, laundry and toilets. The first floor accommodates bedrooms, toilets and bathing facilities. The staff group comprises of a manager, deputy manager, seniors and care assistants, a handyperson, catering, laundry and domestic personnel. Weekly fees for this home range from £ 353- £491. 07. There are additional costs for hairdressing and private chiropody. This information was not detailed in the homes statement of purpose or service user guide. DS0000024969.V351675.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. We carried out this unannounced inspection on one day between 06.55 and 16.00 hours. Two inspectors and a Commission pharmacist were involved with the inspection. Prior to the inspection we sent an Annual Quality Assurance Assessment (AQAA) to the home to complete in order for us to obtain up-to-date information about the home and its functioning. The AQAA was completed to a good standard. We looked at four residents’ files to find out the quality of care being provided to them. This process included looking at care plans, daily records and documents regarding doctors and others visits. We spoke to six residents and asked them about their experiences of living in the home. We carried out a Short Observational Framework for Inspection (SOFI) on Malvern. This process involves us choosing and observing a number of residents over a number of hours concerning for example; their involvement with staff and other people. This observation helps us to make judgements about the residents state of well-being. Our overall analysis of the findings of the SOFI against outcomes for residents was positive. A pharmacist employed by the Commission carried out an audit of medication management, systems and safety within the home and was pleased to find that these are well managed. We looked at three staff files to assess how thorough the homes recruitment processes are and to see how well staff are trained. We spoke to all staff on duty, the majority were interviewed on a one to one basis. They told us about the running of the home, which included positives and areas, which they think, need improvement. We observed both breakfast and lunch-time. We looked at menus and spoke to the management about menu planning and nutrition. We spent most of the inspection day in communal areas of the home both on the residential side and Malvern observing daily routines and engagement between staff and residents. We partly looked at the premises to assess their suitability and safety this included; communal areas, four bedrooms, the kitchen, laundry and gardens. DS0000024969.V351675.R01.S.doc Version 5.2 Page 6 We looked at records concerning health and safety and service certificates to make sure that equipment is receiving the required checks. What the service does well: What has improved since the last inspection? Since the last inspection management changes have occurred. Staff told us; “ We have got someone here for us now, before we were left to get on with DS0000024969.V351675.R01.S.doc Version 5.2 Page 7 things- blamed when things went wrong”. “ Things are better now. The new manager is friendly- different attitude”. The atmosphere of the home was very positive and pleasant. All staff were relaxed. Systems have been put into place to prevent dehydration and weight loss as well as reporting processes where concerns are identified. Expert advice has been sought regarding improving nutrition and meals within the home. Staff spoken to were aware of what they should do if they are given a complaint. Carpets have been provided on the first floor corridors. Home furnishings and new bedding have been ordered to enhance the general environment and comfort. The manager is fully aware of what needs to be done concerning the environment, record keeping and other shortfalls and has made plans how to address these. What they could do better: As the home is registered to provide dementia care and has residents with a range of hearing and eyesight problems information provided examples being; the service user guide and complaints procedure should be produced in pictorial form to aid understanding. The range of fees must be included in the service user guide or statement of purpose to ensure that all residents are aware of the cost of their placement. The statement of purpose and service user guide should detail the fact that dementia care is provided. The home has a number of redecorating and refurbishment needs however, the manager is aware of these and is working to address. DS0000024969.V351675.R01.S.doc Version 5.2 Page 8 The home must ensure that any persons working in the kitchen are adequately trained in food hygiene. Better auditing of kitchen processes must be undertaken to ensure that the kitchen is in good working order at all times to prevent risk to residents. Activities provision in the home must be increased to ensure that all residents have access to regular activity and leisure sessions. Staffing levels must be reviewed to ensure that adequate staff are provided at all times. 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. DS0000024969.V351675.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 DS0000024969.V351675.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): 1,3,4. Quality in this outcome area is good. Information aimed to help future residents’ make a decision about the home’s suitability for them needs more detail and emphasis. No resident moves into the home without having had their needs assessed and assurance that these needs can be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We saw that the last inspection report dated 18 June 2007 and both a service user guide and statement of purpose were displayed on a table by the homes front door. The statement of purpose and service user guide we saw were not valid as they still detailed the name of a manager who has not worked at the home for some time. They did not include the weekly range of fees or inform the reader that the service provides dementia care. DS0000024969.V351675.R01.S.doc Version 5.2 Page 11 The new manager AG provided us with a copy of the new service user guide and statement of purpose. We looked at these and saw that still they did not mention that the service provided dementia care and did not detail the weekly range of fees. These documents therefore do not provide prospective residents full information to enable them to make a decision about the homes suitability for them. We looked at the files of four residents. These all contained completed assessments. The home completes a pre-assessment and initial assessment which are updated once the resident has been living at the home for a few weeks, which is good practice as it gives both the resident and staff the opportunity to review the care and assessment and make changes where needed. We saw that copies of social work assessments had been obtained prior to the admission for the two newest residents. DS0000024969.V351675.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. Resident’s needs are set out in a plan of care and their health care needs are met. Medication systems are effectively managed and are safe. Residents are treated with respect and their right to privacy is upheld. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We were pleased to see that a care plan was in place on all four resident files that we looked at. We were pleased to see that some improvement in making these plans more person centred has been made. We saw that further improvements could be made to include residents in the care planning review process, in that one resident had not been involved in her review when there was no reason to confirm that she was not able in terms of capacity to make choices about her care. We discussed this with the manager DS0000024969.V351675.R01.S.doc Version 5.2 Page 13 who told us that staff are currently awaiting training about the Mental Capacity Act so that they will be aware of their roles and responsibilities under this Act and how to support residents more effectively. We saw that each resident is assessed for their risk of developing pressure sores, for falling, moving and handling and nutrition. In each case these risk assessments had been completed and kept under review, which is a big improvement on findings of our previous inspection carried out in June 2007. During our last inspection we raised serious concerns about how the home recorded and supported residents who were at risk of dehydration. It was pleasing to see that significant improvements in record keeping have been made with the exception of some minor omissions. We spoke to residents who said; “ They give us plenty to drink, I like the way they look after me”. They also said that the doctor comes to see them if they are ill. On the day of the inspection the doctor had been called to (J) as she was not well. Records we saw did not fully detail what staff told others in handover about (J), however the correct action was taken as the doctor was called. When we spent time with residents’ GD and NT we observed that they were appropriately dressed. That their teeth, glasses and nails were clean. This showed us that staff take care to ensure that a good level of personal care is provided. Our pharmacist Inspector undertook an inspection of the control and management of medication within the service. Systems were in place to ensure that medication storage was secure and people who use the service were protected from harm. Safe systems were also in place to ensure that medication was returned when it was no longer needed and also to ensure that safe levels of medication were stored within the home. Senior members of staff had undertaken a medication training course on the safe handling of medication and an up to date medication policy was available to ensure that people who use the service were safeguarded. The majority of the medicine records seen were recorded with a signature for administration and also documented the amount of medication administered. Random medication audits undertaken were accurate, and showed evidence that medication was being handled carefully and safely. Monthly balances of medicines were available. This means that accurate checks on medication could be made to ensure that medication had been administered to the people living within the service. The service made provision for people to look after their own medicines. One person who looked after some of their medication in their bedroom was spoken with who said they were happy looking after their medicines and commented ‘I enjoy my independence’. The service had completed a risk assessment to DS0000024969.V351675.R01.S.doc Version 5.2 Page 14 ensure the safety of the medication and to ensure the safety of people living within the service. We spent most of the inspection time in communal areas where we could observe daily routines and engagement between staff and residents. We saw that staff for example K,D and D were very polite and friendly towards the residents. When we looked around the home we noted that toilet and bathroom doors were shut when in use. We saw the manager knocking the bedroom door of one resident PH before entering. All bedrooms within the home are single occupancy, which helps to promote privacy and dignity. These observations told us that the service does show respect and tries to promote privacy and dignity at all times. DS0000024969.V351675.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. Activity provision within the home needs to be improved upon in terms of regularity and variety to ensure that all residents who wish to can engage in suitable and meaningful activities. Visiting times are open and flexible. Residents are offered choices, encouraged to maintain control of their lives and are treated with respect. Meals provided are varied and interesting. The service is taking positive action to promote a healthy diet for all. This judgement has been made using available evidence including a visit to this service. EVIDENCE: When we entered the residential lounge at 07.00 hours there were five residents sitting in chairs including N and G. None of these looked tired, they were alert eating biscuits and drinking tea. I asked G if she minded getting up that early she replied; “ Like getting up early”. When we listened to the DS0000024969.V351675.R01.S.doc Version 5.2 Page 16 night/day staff handover we heard the senior telling day staff that G had actually refused to go to bed the night before and had been up all night. We asked the night staff senior about residents getting up early and were told; “ No one is made to get up early”. We did not see any evidence to suggest that the night staff have to get residents up early before they go off duty. During the morning we saw residents such as J arrive in the dining room well after half past nine. On Malvern we saw good practice as the preferred rising and retiring times of each resident are recorded. However, we did observe that not all residents were able to get up at their preferred times as staff were busy with other residents. We saw that there were posters by the front door advertising a pending clothes promotion from an external seller. The manager told us that the day before although early, staff had put Christmas carols on for the residents, which they had enjoyed. We saw the day- senior encourage a resident to do some knitting. We did not see any other activities or events taking place. We spoke to the manager about activities provision who confirmed that it is a problem. She said; “ The activities co-ordinator left after a short time of being here. We have tried the job centre but we don’t think we will get anyone until after Christmas”. We observed residents on the residential section and although we did see some interaction from staff there was nothing else to stimulate them. For long periods we observed that they were just sitting in their chairs. Our observations on Malvern show that residents get along well with each other, there was a high level of interaction between them. Staff confirmed that they find it a struggle to do activities when there are only two of them on duty. Malvern has a rabbit in a hutch in the lounge, which is let out to run about freely at times, which is a source of enjoyment to most residents. We did raise concerns about the safety of this rabbit as we were told it had been struck by a resident’s walking stick We discussed the activity situation with the manager and operations manager and suggested that until someone is recruited for activities a staff member could be given additional hours to dedicate to activities. The homes latest service user guide page 9 has a section regarding activities titled ‘ participation in care home life’ which reads; ‘ We consider it very important for our service users to have available a range of suitable recreational activities from which to choose. We will encourage and help you to find activities in which you would like to participate’. The evidence we found during the day did not give us confidence that this is happening in practice. We have never from any source been alerted about restricted visiting times, which is positive as this means that visiting times are open. The homes latest service user guide page 11 states when visitors may be asked to wait as follows;’ We have visiting at most times of the day.. however should your visitors arrive during meals or when being attended to by our care staff, your DS0000024969.V351675.R01.S.doc Version 5.2 Page 17 visitors will be made welcome and asked to wait until you are ready to see them’. We saw information displayed on posters and leaflets within the home advertising external support services. The manager told us that all the required papers are forwarded to the local Council to allow those residents who wish to, to vote. When we looked at bedrooms we saw that residents had brought a range of personal effects into the home. These processes promote choice and personal control over residents lives. The manager told us about recent initiatives that had been taken by the home to improve diet and nutrition. One of which being the securing of training titled ‘Get cooking’ from the local Primary Care Trust which is due to commence in January 2007. The manager showed us pictures of food items and told us “ We are going to put these into a book and use them in the home”. This is good as it may raise understanding of meals available to residents who have cognitive or sensory problems. We observed the breakfast and lunch -time on both the residential unit and Malvern. We saw that the dining room on the residential unit was nice and bright. Tables were nicely laid with tablecloths and floral centrepieces. This was not the case on Malvern, tables were not laid on this unit and there was no salt, pepper or sauces available for use. We heard staff asking each resident what they would like for breakfast and giving them choices. We saw that a range of cereals and hot breakfast options were available. We saw some residents eat cereal followed by toast and marmalade. Two male residents chose a hot breakfast one had tomatoes and toast, the other bacon, tomatoes and toast. We asked them about their breakfast and they told us; “ enjoyed it” and “ It was nice”. One carer told us that three residents like to have their breakfast in their rooms. Shortly after we saw breakfast trays being taken out of the dining room. We saw that lunch consisted of chicken pie or savoury mince with peas, potatoes and carrots followed by chocolate pudding and custard. The meals looked attractive and smelt appetising. We observed that all but three residents ate their meal. We heard a carer asking these three why they had not eaten much and offering them something else. We saw that a fruit bowl containing apples, bananas and oranges on the small table in the residential lounge and plates containing fresh, sliced carrot and cucumber. Whilst this is positive as it makes healthy snacks available, our observations told us that residents did not help themselves to these snacks. DS0000024969.V351675.R01.S.doc Version 5.2 Page 18 We suggested that the plates were taken to the residents and offered as they may be more inclined to eat them. We observed that hot drinks and biscuits were offered between meals. We saw the senior carer sitting and encouraging one resident to drink which is positive as the senior was aware that this resident was prone to take limited fluids and her action could prevent risk of dehydration. One staff member told us; “ Since you last came the meals have improved, especially at tea time. There is always a hot option now whereas there wasn’t before”. One resident told us; “The food is good, its ok for me”. Another resident told us that she enjoyed her breakfast. DS0000024969.V351675.R01.S.doc Version 5.2 Page 19 DS0000024969.V351675.R01.S.doc Version 5.2 Page 20 DS0000024969.V351675.R01.S.doc Version 5.2 Page 21 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18. Quality in this outcome area is good. Processes are in place to ensure that residents and their representatives can make a complaint if they wish. These processes may be accessible for more residents’ however, if they are produced in different formats. Processes are in place in the home to promote the safeguarding of residents’. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home or we have not received any complaints since before the last inspection. This evidenced by reading the complaints log and speaking to the manager. The home has a written complaints procedure, which is on display in the home and is detailed on page 14 of the service user guide. We asked the manager if we could have a look at complaints procedures that have been produced in different formats such as audiocassette and pictures. The manager confirmed that the audiocassette was not available on site and to date no pictorial complaints procedure has been produced. DS0000024969.V351675.R01.S.doc Version 5.2 Page 22 We highlighted concerns in the previous inspection report dated 18 June 2007 when we identified from daily notes that one female relative had been dissatisfied with the care her husband received when she relayed this to staff no action was taken. During this inspection the manager confirmed that she encouraged an open door policy and told relatives that if they had any concerns to make her aware of them. Procedures have been relayed to staff since the last inspection. One staff member told us “ Yes we have been told about complaints processes since the last inspection”. Another said; “ If I received a complaint I would deal with it and record or report”. This evidence shows that previous shortfalls concerning complaints havebeen addressed. We have not received any allegations of abuse since before the last inspection. The homes AQAA stated that one situation had been referred in the last 12 months. When we asked staff about any concerns or if they were aware of any allegations one told us of a situation but we could not find any more information to confirm this. Another said; “ No nothing. Nothing about staff or residents”. We did not find any written records to suggest any recent allegations or incidents of abuse. The manager confirmed that all staff have received abuse awareness training. We looked on the training matrix and saw that this was correct, all current staff with the exception of one new one have received this training. DS0000024969.V351675.R01.S.doc Version 5.2 Page 23 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): 19,26. Quality in this outcome area is adequate. The home has some redecoration and refurbishment needs which the manager is in the process of addressing. There was a strong odour in Malvern unit, which needs to be managed and eradicated. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home due to its size and general wear and tear does have some redecoration and refurbishment needs. We saw that paintwork in many areas was chipped and tired especially in corridors. Carpets on Malvern stained. The DS0000024969.V351675.R01.S.doc Version 5.2 Page 24 garden on Malvern although made safer, needs work to make it more attractive and appealing. Some toilets and bathrooms need redecoration. We saw a number of windowpanes had lost their seals making it difficult to see out of. The manager agreed and told us that she was aware there was a lot to do environmentally. She was especially unhappy with decoration on Malvern unit. She told us that orders had been made for new bedding and that she had a programme of redecoration. She showed us a small lounge on the residential unit, which previously had been the manager’s office. This room was very homely. One wall had recently been decorated with a floral paper. We did see that new carpets had been laid on all corridors on the first floor. The residential unit we saw to be much brighter than Malvern. The dining room floor laminated which made it look clean and bright. As during the last inspection carried out we did detect an odour on Malvern. Whereas we had noted an odour in a bedroom previously this inspection the odour was present throughout the whole ground floor corridor, which emanated from a number of bedrooms. Whilst doing our SOFI observation in the dining room we could smell stale urine, which we felt, was coming from the carpet and chairs. DS0000024969.V351675.R01.S.doc Version 5.2 Page 25 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. Further review of staffing levels is needed to ensure numbers meet the needs and requirements of all residents. Over fifty percent of the care staff team have achieved NVQ level 2 or above meaning that residents are in safe hands. Recruitment practices need some fine-tuning to ensure that residents are fully protected. Staff in general receive the training they need. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the present time five carers are provided during waking hours,three on the residential unit and two on Malvern. Three waking carers are provided at night. We made a requirement in our last inspection report dated 18 June 2007 for staffing levels to be reviewed. During this inspection we identified that staffing levels still need further review. The home does have some empty beds at the present time on both the residential and Malvern. However, feedback from staff suggested that staffing still is not always adequate as follows; “ Really hard at night with only 3 staff. Have to keep going from unit to unit”. “ Need DS0000024969.V351675.R01.S.doc Version 5.2 Page 26 more staff I’ve experienced time that I was on own in one unit”. “ Staffing levels not enough, busy and rushed”. “ Staffing levels poor during evening time as we do not have a cook and staff have to cook the hot option”. During our observations particularly during the morning we witnessed times when there were no staff in the residential lounge and therefore no interaction with residents. We witnessed one resident asking after breakfast to be moved from the table. We heard a carer asking her to wait until a second carer came. The resident got very agitated by having to wait and kept saying “ Hurry up, hurry up”. On Malvern one lady had to wait for over an hour in the dining room for staff to become free enough to assist her with her breakfast. We discussed the need for higher staffing levels with the manager and the operations manager during inspection feedback as evidence shows that the previous requirement has not to date, been met. During the inspection we observed staff and saw that they were hard working. They were polite and friendly to the people in their care. The majority of care staff have achieved NVQ level 2 or above in care. This means that these staff have all been assessed as being competent to undertake their work. Staff spoken to during the inspection all confirmed that they have achieved these NVQ awards. We looked at three staff files. In general these were of a good standard and showed us that robust processes are in place concerning recruitment, which is good as this increases resident safety. We did discuss with the operations manager about further improving processes to evidence safeguards if staff are employed on a POVA first before their enhanced disclosures are received. The operations manager told us in detail about processes that she is implementing such as supervision of these staff and on going mentoring which will all be documented as future evidence. Generally we saw that training is offered and the majority of staff have induction and required training. One concern highlighted was food hygiene cooks which will be detailed in the next section of this report. DS0000024969.V351675.R01.S.doc Version 5.2 Page 27 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 good. Management processes within the home are robust. Efforts are made to determine the views of the residents concerning the running of the home. Residents’ money is held securely. Health and safety within the home is promoted, more attention however needs to be paid to ensuring effective kitchen processes to prevent food risks to residents. This judgement has been made using available evidence including a visit to this service. DS0000024969.V351675.R01.S.doc Version 5.2 Page 28 EVIDENCE: Since the last inspection a new manager has been appointed. This manager told us that she is in the processes of applying for her registration with us. She also told us that she has recently completed her Registered Managers Award and is waiting for her certificate. We met this manager. She was involved throughout the inspection day. We identified that she has great commitment and drive and is determined to raise standards within the home. The manager told us; “ When I read the last report it put me off going for the job. But it is a challenge. We have already improved a lot of things such as records and the premises”. Staff spoke to were positive about this manager saying; “ We have got someone here for us, before we were left to get on with things”. “ Things are better now. The new manager seems nice and friendly, attitude different”. We observed the manager at times throughout the day. She was out on the floor checking things and speaking to staff and the residents. The manager in her short time in the home October 2007 has a lot of knowledge about its running, the staff and residents. We looked at records concerning quality assurance processes. We saw that monthly managers audits are undertaken looking at different areas each month. We saw that resident questionnaires are in use and an analysis of these made available in the service user guide. We saw minutes to confirm that staff meetings are held regularly. We checked three resident monies held in safe keeping in the home. The process for this is detailed in the service user guide. Small amounts of money are pooled in a cash float. The rest of the money is put into individual resident bank accounts. We saw that records of money received and spent are kept. We randomly looked at records concerning health and safety and the servicing of equipment. We found those relating for example; to the fire alarm (recommendation made for switches to be blanked), emergency lighting; hoists and lifts in order. We saw evidence to prove that portable electrical appliances have recently been checked. We saw that a recommendation had been made for a new gas hose from the person who issued the latest gas landlords safety certificate. We saw that there was a problem with water temperatures in rooms 8 and 9 in that they were too high. Records showed that the person taking the temperatures had identified a problem as retesting had taken place. However, we saw that the temperatures recorded were still too high. The manager DS0000024969.V351675.R01.S.doc Version 5.2 Page 29 assured us that the problem had been referred to the appropriate person and was in the process of being dealt with. We saw that the radiator and hot pipe work in the new small lounge was not guarded and was therefore a possible risk to residents. The manager told us; “ We have measured up to have these guarded and it will be done as soon as possible”. We were concerned about our findings in the kitchen. We saw for example; hat sauces in the fridge located to the rear of the kitchen by the window had not been date labelled. We saw a cereal box on the shelf in the dry store, which had the outer and inner wrappers open. We saw flour in tubs on the shelf with no use by date. We saw cheese in the fridge, which did not show a use by date. We saw a big saucepan of soup on the stove in the kitchen. We felt this it was lukewarm. A staff member told us; “ That is for tea”. When we saw this soup it was 3 PM in the afternoon, which would have meant it standing there for at least another hour. We saw that there was a build up of debris under workstations. We saw that the small cake container had been left on the rack on the cooker and still had cake mixture on it. We saw three chocolate puddings under the grill part of the oven (top). We saw three black dustbin liners under the work surface by the door leading to the dining room. They contained rubbish. We were further concerned when we asked to see the cook for the day’s food hygiene certificate. The manager was unable to provide one. We looked on the training matrix. This did not show us that the cook has received food hygiene training. The manager was concerned by our findings and assured us that the cook would receive training from her within a week and would be put forward straight away for formal training. She also told us that in the interim to prevent risks to residents she would herself do twice daily checks of the kitchen. DS0000024969.V351675.R01.S.doc Version 5.2 Page 30 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 x 3 3 x 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 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 3 2 x x x x x x 2 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 2 DS0000024969.V351675.R01.S.doc Version 5.2 Page 31 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 OP27 Regulation 13(4) (c)18(1) (a) Requirement Staffing levels generally need to be reviewed. One specific area are break times on the dementia unit which must be adequately covered to ensure that there are 2 staff at all times. This requirement has been made to reduce risk and to keep service users’ safe. Timescale of 10/07/07 still outstanding. Timescale for action 15/01/08 DS0000024969.V351675.R01.S.doc Version 5.2 Page 32 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 4 5 Refer to Standard OP1 OP1 OP8 OP12 OP26 Good Practice Recommendations The service user guide and statement of purpose should inform the reader that dementia care is provided. The service user guide should detail the full range of weekly fees. Serious consideration should be given to providing a bath in the dementia unit to give service users’ a choice. Suitable activity provision should be available to meet the recreational and stimulation needs of the service users’. The odour in the home should be managed and eradicated. Appropriate hand wash signs should be available in all toilets to prevent infection transmission. DS0000024969.V351675.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 DS0000024969.V351675.R01.S.doc Version 5.2 Page 34 - 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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