Inspection on 14/05/08 for Attlee Court

This inspection was carried out on 14th May 2008.

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

Attlee Court 13/05/09

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

CARE HOMES FOR OLDER PEOPLE Attlee Court Attlee Street Normanton Wakefield West Yorks WF6 1DL Lead Inspector David White Key Unannounced Inspection 08:45 14th May 2008 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 Attlee Court DS0000070662.V362141.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. Attlee Court DS0000070662.V362141.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Attlee Court Address Attlee Street Normanton Wakefield West Yorks WF6 1DL 01924 891144 01924 897755 attleecourt@btinternet.com 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) Minster Care Management Limited Mrs Lynne Notley Care Home 66 Category(ies) of Dementia (66), Mental disorder, excluding registration, with number learning disability or dementia (66), Old age, of places not falling within any other category (66), Physical disability (66) Attlee Court DS0000070662.V362141.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N; to service users of the following gender: Either; whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP; Dementia - Code DE; Mental Disorder, excluding learning disability or dementia - Code MD; Physical Disability - Code PD. The maximum number of service users who can be accommodated is: 66 Not applicable 2. Date of last inspection Brief Description of the Service: Attlee Court is a purpose built 66-bedded care home on two levels, which opened in July 2000. Minster Care Management took over the ownership of the home in October 2007. The ground floor is designed to accommodate older people who require either residential or nursing care. The upper floor is designed to accommodate older people who have a diagnosed dementia type illness and who require residential or nursing care. Private accommodation comprises of single en-suite bedrooms throughout. The home provides appropriate communal accommodation with each floor having separate communal facilities. Occupants of both floors share the garden area although access for those living on the top floor is difficult. The premises are situated in Normanton within walking distance of the local shops. The town centre is a short distance by car or local transport. The home has a statement of purpose that explains the aims, objectives and philosophies of the home. The most recent inspection report is made available to anyone who wishes to see it upon request from the home’s manager and can also be found on our website www.csci.org.uk. The current residential care fees at the time of the visit on 14th May 2008 are £388 per week, and nursing fees are individually assessed. Attlee Court DS0000070662.V362141.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 people who use the service experience adequate quality outcomes. The Commission for Social Care Inspection inspects homes at a frequency determined by how the home has been risk assessed. The inspection process has now become a cycle of activity rather than a series of one-off events. Information is gathered from a variety of sources, one being a site visit. More information about the inspection process can be found on our website www.csci.org.uk We went to the home without telling them that we were going to visit. This report follows the visit that took place between 8.45am and 5.15pm on the 14th May 2008. The purpose of the visit was to make sure that the home was operating and being managed in the best interests of people living there. Information has been used from different sources for this report. These sources include: • • • Reviewing information that has been received about the home since the last inspection. Information provided by the manager on an Annual Quality Assurance Assessment questionnaire. Surveys returned by four people who live at the home, four relatives and three staff members. Survey information requested from health and social care professionals was not returned. During the visit time was spent talking to people who live at the home, staff, management, a relative and a health professional. We observed staff caring for people in communal rooms, looked at various records relating to care, staff, and maintenance, and looked at some parts of the building. The registered manager was available throughout the site visit and the findings were discussed with her at the end of the inspection. What the service does well: People liked the food on offer at the home and one person commented that the ‘meals are very good’. Choices are available at mealtimes and this helps in making sure that people receive food that they like and enjoy. Attlee Court DS0000070662.V362141.R01.S.doc Version 5.2 Page 6 People said that they are able to make their own choices about their daily routines. This helps people to have control over their lives. One person said, ‘the service I receive is better than I would have anticipated’. The home employs activity organisers who provide activities to individuals and in groups. One person said, ‘activities are planned with us, I especially like the bingo’. Family and friends can visit the home and one person said ‘staff are taking me every week to see my relative who is in hospital’. This helps people to maintain their relationships with family and friends. People feel that their concerns are listened to and acted on. One person said, ‘on the few occasions I have had problems, this has always been responded to in a helpful way’. Another person commented ‘you can discuss anything with the manager at any time, she always listens’ and a relative said, ‘any problems are always dealt with promptly’. People were complimentary about the staff team. One person said, ‘staff are kind and helpful, some of them are brilliant’. The home encourages people to tell them what they think about the service. There are meetings with people in the home and questionnaires are sent out every year. This enables people to have their say and be involved in decisionmaking about how the home is run. What has improved since the last inspection? What they could do better: More information about people’s individuality could be included in the assessment form before people are admitted to the home so that people can feel confident that the home will be able to support them in living the life they choose. When there is a risk to the person or someone else this could be assessed and a care plan could be put in place and kept under review so that proper action is taken in response to people’s needs and staff are clear about what they need to do to reduce risks to people. People could be more involved in how their care is planned and monitored. Records of people’s daily lives could include more information about how the person has spent their day and what they have enjoyed This would help in making sure people receive care and support in a person centred way. Attlee Court DS0000070662.V362141.R01.S.doc Version 5.2 Page 7 Medication procedures could be better so that the correct dosage of medication is always given, medication is only signed for as being administered when it has been taken and clear instruction is in place when medication is not to be given. Staff could update their knowledge of medication procedures through further training. This will all help in making sure that people’s health needs are met in a safe way and will minimise the risk of medication errors. Toilets could be made accessible to people at all times to help maintain the comfort and dignity of people living in the home. In the unit that accommodates people with enduring mental health problems, toilet areas could have picture signs on them to help people to be able to recognise them. This will help to maintain people’s independence and comfort and reduce confusion. Wheelchairs could be stored in more suitable places so that people are not at risk from any injury from them when in the bathroom. The home’s policy on how to keep people safe from abuse could be changed to include more detail about the role of other agencies in the process and their contact details. This will help in making sure proper procedures are followed to keep people safe. Staff could have more up to date training on how to deal with verbal and physical aggression in order to develop their skills and knowledge in managing these situations. The registered provider could look more closely into the possible reasons for the number of incidents between people living in the unit accommodating people with enduring mental health problems and take any necessary action from this to minimise risks to people’s safety. 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. Attlee Court DS0000070662.V362141.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 Attlee Court DS0000070662.V362141.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. People have their needs assessed before they are admitted into the home and are given the information they need to help them with their decision-making about moving into the home. EVIDENCE: The home has a statement of purpose and service user guide that provides information about the care and services on offer at the home. The needs of people who use the service are assessed before they move into the home, to make sure the home can meet their needs. The manager said that she, the unit manager or another senior member of staff would visit the person either in hospital or in their own home. Pre-admission assessments are completed and information is obtained from other sources such as the placing Attlee Court DS0000070662.V362141.R01.S.doc Version 5.2 Page 10 authority that details the level and type of support the person will need. This information is then used as a basis for the care plan. One person living at the home said, ‘before I came to live her I was invited for a visit and given some information about the home, so that I could make a decision about whether I wanted to move here’. Surveys returned by people living in the home and relatives indicated that they were given enough information about the home before making a decision about whether it was suitable. Completed pre-admission assessments show that admission procedures are being followed. The assessment form could be updated to show that the home recognises people’s individuality and can respond to individual needs, for example, in cases where people choose to be involved in relationships with people of the same gender. The home does not provide intermediate care. Attlee Court DS0000070662.V362141.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. People’s personal and health care needs are mostly met. However, some risks associated with people’s care could be better planned for and monitored in the unit accommodating people with enduring mental health problems. There are some shortfalls in the medication procedures that put people at risk. EVIDENCE: Each person has an individual care plan detailing people’s individual needs and the actions that staff need to take to meet these. The care plans gave life stories and included information about people’s likes and dislikes. One person who likes watching sport had satellite television in their bedroom. In two cases there was specific information about the number of pillows, preferred nightwear and lighting that people preferred to assist them with their sleep. Some care plans included information about meeting people’s sexuality needs. Staff said they understood the care plans and were able to follow them. Attlee Court DS0000070662.V362141.R01.S.doc Version 5.2 Page 12 The staff review care plans on a regular basis. However, the care records that were looked showed little evidence that people in the home or their representatives are involved in the planning and review of their care. There are handover periods between shifts so that information can be passed on. The daily records were up to date, however they contained a lot of information about how people’s physical needs are met but very little about how people actually spend their time. All the care plans seen contained a number of risk assessments in relation to falls, pressure care, nutrition and moving and handling. In most cases where risk had been identified there was a care plan in place detailing how this was to be managed. Where people needed bedrails this had been assessed and agreed with the person or their relatives. Some people chose to have their own bedroom key and a risk assessment was undertaken in each case to support how decisions had been reached about this. One person was assessed as being at risk of choking from food and the care plan was well detailed and included information from the speech language therapist about the management of this issue. In the unit that accommodates people with enduring mental health problems, one person does not always take his medication and the assessment information stated that this could lead to deterioration in the person’s mental health. However, the care records did not have any written information about possible risks from this or actions that needed to be taken to minimise any risks. In another case there had been a serious incident in which one person had attacked another person living on the unit. Whilst a risk assessment had previously been put in place regarding the person’s potential for aggression, this had not been reviewed and updated following the incident so it was not clear if proper actions had been taken in response to this to keep people safe. The records showed that people have access to a range of health care services. General Practitioners (GPs) visit the home and a doctor who specialises in mental health illnesses in the elderly holds regular clinics in-house to review people’s care. The home has links to a number of local mental health teams and people are referred to health specialists as needed. The care records contain a section where health input is recorded along with outcomes from visits and appointments. People living in the general nursing and residential unit said that they received the care they needed. One said, ‘staff are kind and helpful, some are brilliant’. Due to the complex needs of the people with enduring mental health problems it was not possible to seek their views and opinions. People’s personal appearance had been attended to and staff could be seen interacting with people in a friendly manner. Attlee Court DS0000070662.V362141.R01.S.doc Version 5.2 Page 13 Surveys returned by people living in the home and relatives provided positive comments about the home. One person living there said, ‘staff are very helpful’ and another, ‘the commitment of staff is more than adequate’. A relative survey commented ‘the care home could not improve the way they look after my relative’ and another said, ‘Atlee Court is a fantastic care home’. Trained nurses look after and administer the medication in the nursing parts of each unit. Care staff who have received appropriate training are responsible for the administration of the medication in the areas where non-nursing care is provided. In a recent incident two care staff had administered an incorrect dose of medication because they had followed directions on the medication box instead of the Medication Administration Record, not realising that the GP had changed the dosage of medication to be given. The manager has taken action to prevent this situation happening again. Whilst speaking to a person living in the general nursing unit it was observed that some medication was lying on their bedside table but had been signed for on the medication record as being taken. In another case one person was only to be given one type of medication if their pulse rate was satisfactory. Whilst the pulse rate was recorded on the medication record, there was no instruction about under what circumstances the medication was to be given or not. It is recommended that staff receive further medication training to update their skills and knowledge. People said that they feel they are treated with respect and dignity by the staff. One said, ‘staff are helpful when I am getting a bath’. People can have a bath and shower at any time and a regime is in place to help support people who have difficulty with their communication with their bathing needs. The home has links with local advocacy services so that people who live at the home can have independent support in helping them to make their own decisions. Attlee Court DS0000070662.V362141.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. People enjoy a lifestyle to suit their needs. EVIDENCE: The home employs three activity organisers who provide an activity programme on a daily basis in all units of the home. The activity programme is on display and activities are provided within a group setting and on an individual basis. Records are made about people’s participation in activities and their level of enjoyment. This is good and helps to make activities person centred to meet individual needs and preferences. One person said, ‘Activities are planned with us, I especially like the bingo’. Another person said’, ‘I can join in the activities if I want to but I am not always bothered’. The activity organisers are planning for a trip out to the seaside and some people go out for local pub lunches and to other local attractions. Church services are also held at the home. At the time of the site visit the hairdressers were visiting the home. One person said, ‘I enjoy their Attlee Court DS0000070662.V362141.R01.S.doc Version 5.2 Page 15 visits and the manicure sessions’. All four of the surveys returned by people who live at the home said that there are a sufficient number of activities on offer if people want to join in. People who were able to comment said they lived their daily lives as they choose and can get up in a morning and go to bed when they want. Most staff had attended some training called ‘yesterday, today and tomorrow’ and staff said that this helped them to understand the importance of activity in people’s daily lives. Relatives are welcome to visit the home at any time as was seen as the time of the site visit. A relative said, ‘I am able to visit whenever I want and the staff keep me informed about things’. Staff are currently supporting one person to visit her relative who is in hospital. Two people living in the home have formed a relationship and staff are providing the right support for it to continue. People said that they enjoy the meals that are provided. One comment was ‘the meals are always very good’. At each mealtime there is a choice of two main dishes. This includes in a morning when people can have a cooked breakfast if they wish to do so. People have the opportunity to eat their meals in their bedroom and or in the dining room and are given assistance with this if needed. The catering team are aware of any specialist dietary needs and the menus offer healthy eating options. Attlee Court DS0000070662.V362141.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. People’s concerns are listened to and acted on to safeguard people from possible harm. EVIDENCE: The home has a complaints procedure that is on display in the foyer of the home and a summary of the procedure is available in an information booklet called the ‘service user guide’. The complaints records showed that people’s complaints have been logged and investigated and there is a record of the outcome from each complaint. People who were able to communicate their views all said that they feel ‘safe’ at the home and would ‘speak to the manager about any concerns’. One survey returned by someone who lives at the home said, ‘on the few occasions I have had any problems these have been responded to in a helpful way’. Another person said, ‘you can discuss anything with the manager at any time, she always listens’ and a relative told us that after making a complaint the problems had been ‘dealt with promptly’. The training records contain evidence that staff receive training on the protection of vulnerable adults as part of their induction training and at regular Attlee Court DS0000070662.V362141.R01.S.doc Version 5.2 Page 17 intervals after this. Staff were able to say what action they would take if they suspected abuse or had an allegation of abuse made to them. The home has a policy on how to safeguard adults from abuse. However, this needs updating to include information about the role of the police, local authority and other agencies in the process and about the local point of contact if a safeguarding referral is needed. Since the new owners took over in October 2007, ten incidents have been referred to the local authority as safeguarding matters. Most of these referrals are as a result of incidents between people living in the unit for people with enduring mental health problems. This has resulted in a number of meetings between the home and health and social care professionals to look at what actions need to be taken in response to the incidents and to minimise risks of further incidents. The number of incidents referred to the local authority in the unit for people with enduring mental health problems does show that staff are reporting incidents properly to safeguard people from possible harm. Staff receive specific training on how to deal with physical and verbal aggression to minimise risks to the person or others. The training records show it is some time since staff had this training and it is recommended that staff receive more updated training in this area. The home is participating in a pilot project for the use of behaviour monitoring charts, which look at possible causes of people’s behaviour and the consequences from this by working closely with the Nursing Homes Mental Health Liaison Link Nurse. The aim of this is to improve the knowledge of the staff team in ensuring a positive approach to any problems that may occur. Attlee Court DS0000070662.V362141.R01.S.doc Version 5.2 Page 18 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 and 26 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. People live in a comfortable and friendly environment although improvements in some aspects of the environment would help to maintain people’s independence, comfort, dignity and safety. EVIDENCE: The accommodation is over two floors. People on the first floor could have access to the garden area via a passenger lift. People’s bedrooms were personalised and people could have their own key if they wanted. People said that they liked living at the home and were pleased with their bedrooms. A visiting health professional said ‘it is a while since I visited the home but the environment looks a lot better for the refurbishment work’. Attlee Court DS0000070662.V362141.R01.S.doc Version 5.2 Page 19 Carpets and bedding have been updated and new furnishings purchased. A lot of re-decoration work had taken place, especially on the first floor that accommodates people with enduring mental health problems. Staff said, ‘the home is brighter and more pleasant for people’. Bathroom areas on the first floor had been themed to provide a relaxing environment for people when using it and some sensory aids were available to provide relaxation for people. New equipment had been purchased for all parts of the home to assist in the prevention and management of pressure ulcers. Bathroom areas provide specialist baths to enable people with mobility problems to bathe safely. Whilst looking around the environment it became evident that communal toilet areas were locked. The manager explained that in some cases toilet areas are locked if the floors are wet after being cleaned to protect people’s safety. She accepted that in all other circumstances toilet areas should be accessible and not locked. This is particularly important in areas where people have confusion and disorientation and have difficulty in communicating their needs. The manager addressed this matter immediately. Two wheelchairs were being stored in one bathroom on the first floor, although the bathroom was locked so people did not have access to this area so were not at risk from injury or tripping. It is recommended that the toilet doors on the first floor have picture signs on them to assist people who have confusion and disorientation to be able to recognise them. A survey returned by a member of staff following the site visit said that the manager is strict about footplates being in place when wheelchairs are being used but that footplates can be difficult to find on occasions. The manager needs to look at this possible issue and take any necessary action in order to make sure that people have the right aids and equipment to help with their mobility and safety at all times. The home was clean and tidy on the day of the site visit and there were no odours. Staff said that there were plentiful supplies of wipes, aprons, gloves and hand washing facilities to help them maintain good hygiene standards. There had been a recent infection at the home, which had been managed properly. Proper procedures and measures had been put in place to minimise the effects from this and guidance had been sought from the appropriate agencies. A recent staff survey indicated that the laundry was very warm to work in. The manager said that she was aware of this and extra ventilation is to be provided in this area. Attlee Court DS0000070662.V362141.R01.S.doc Version 5.2 Page 20 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 the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. People at the home are cared for by a sufficient number of staff who receive the training they need to meet people’s needs. EVIDENCE: Staff and people who live at the home did say that they felt staffing levels were adequate. People said that staff usually responded to call bell requests within a reasonable time although one person did say that on one occasion a member of staff had told her she would be ‘with her in a minute’ but did not return and the manager was taking this issue up with the member of staff concerned. The home has their own bank staff to cover vacant shifts and agency staff are occasionally used though where possible these tend to be the same staff. People said, ‘staff are kind, caring and helpful’. One relative commented ‘staff are friendly’ and another said’ ‘the home has very good experienced staff’. Two staff files were looked at and these showed that the required checks are completed prior to new staff starting in post. All the surveys returned by staff indicated that proper checks were carried out before they began working at the home. A new member of staff who was on duty at the time of the site visit said, ‘I had to wait for my police check to come back before I could start Attlee Court DS0000070662.V362141.R01.S.doc Version 5.2 Page 21 working here’. The home’s application form does not ask for a full employment history. This needs to be addressed so that any gaps in employment can be checked and followed through to protect people from potentially unsuitable workers. This was discussed with the manager who will be addressing this. The home has a policy about equality and diversity and the recruitment procedures showed evidence that this was happening through the appointment of staff from different cultural backgrounds. Training is provided on safe working practices such as moving and handling and fire safety as well as on more specialist subjects such as dementia care, palliative care and epilepsy. The manager has a training matrix so that she has a record of what training staff have undertaken, training they will need and when training is due. The home has ongoing National Vocational Qualification (NVQ) training that helps to ensure that people are cared for by adequately trained staff. One new member of staff confirmed that she had received induction when she began her employment so that she was clear about her responsibilities and had the information to meet people’s needs. Staff said that they receive supervision and have staff meetings to discuss issues about the home. Attlee Court DS0000070662.V362141.R01.S.doc Version 5.2 Page 22 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 and 38 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. There are suitable arrangements in place to make sure the home is managed properly and people’s views are taken into account. Proper attention is given to health and safety matters although the reasons for the number of safeguarding referrals could be looked into more closely. EVIDENCE: The registered manager is well experienced in running the home and has a management qualification. People living in the home said they felt comfortable in going to see her about any concerns and staff described her as approachable and helpful’. Attlee Court DS0000070662.V362141.R01.S.doc Version 5.2 Page 23 In a small number of cases the home keeps minimal amounts of people’s personal monies in their safe. The manager said that mostly relatives, solicitors or the local authority look after people’s personal allowances. Records and receipts are kept of all transactions so that money can be easily accounted for. The manager provided us with information about the home in their Annual Quality Assurance Assessment (AQAA). This information let us know about what they are doing to improve outcomes for people who use their service and about improvements they intend to make to continue with this. A staff survey said, ‘the manager comes in early to observe the night and day staff’. Minster Care Services carry out a number of company audits on different aspects of the home and completed audits were seen for such things as medication and care records. Action plans are drawn up from the findings of the audit and any areas of concern are addressed. Despite audit systems being in place the number of safeguarding referrals in relation to incidents in the unit for people with enduring mental health problems remains high. Whilst staff should be praised for reporting these incidents and acting appropriately in response to these, it is recommended that possible underlying reasons for the number of incidents is more closely looked into to look at why so many incidents are happening. The manager recently sent out annual questionnaires to people using the service, staff and relatives. Those returned were looked at and provided positive comments about the care and services on offer. Issues raised by some staff in the questionnaires had been dealt with. Staff meetings and meetings with people who live at the home are also held to enable people to voice their opinions and views. The manager produces a newsletter that is on display in the home. This keeps people updated about what has been happening in the home and future plans. The manager is intending to encourage family and friends of people living in the home to develop a relative’s forum so they can have more involvement in the running of the home. The self-assessment form completed by the home (AQAA) indicated that all the required maintenance and servicing of equipment is up to date and the records we looked at confirmed this. Staff receive regular health and safety training that is updated as needed. Attlee Court DS0000070662.V362141.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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 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 2 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Attlee Court DS0000070662.V362141.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? N/A 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 OP7 Regulation 13 Timescale for action A risk assessment must be put in 14/07/08 place and updated as needed when there is an identified risk to a person or to others from their behaviour. This will help to ensure people’s safety. In order to reduce the risk of 14/06/08 harm to people, arrangements must be put in place to make sure that: • People receive the correct dosage of medication that has been prescribed by the General Practitioner. • Medication is not to be signed for as being administered until it has been taken. • Clear instruction is given about under what circumstances a certain medication is to be given or omitted. Toilets must be accessible at all 14/06/08 times to people who live at the home. This will enable people to maintain their independence, privacy and dignity. Requirement 2 OP9 13 3 OP19 12 Attlee Court DS0000070662.V362141.R01.S.doc Version 5.2 Page 26 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 OP3 Good Practice Recommendations Pre-admission assessment information should include questions about race, age, gender (including gender identity), sexual orientation, disability and religion and belief. This will help in making sure people’s individuality is recognised and responded to in an appropriate way to meet their needs. To enable care to be more person centred: • People who use the service and/or their representatives should be more involved in the care planning process where this is practically possible. • Daily records should include more meaningful information about how people have spent their day and things they have enjoyed. All staff that administer medication should receive further training in the safe handling of medication. This will provide staff with up to date knowledge and skills and will help to reduce any risks from medication errors. To make sure that people follow proper procedures in response to allegations of or incidents of abuse, the home’s safeguarding policy should include: • Information about the role of the local authority, police and other agencies in safeguarding issues. • Details about the local point of contact if a safeguarding referral is needed. Staff should receive refresher training on how to deal with verbal and physical aggression. This will provide staff with updated skills and knowledge in managing difficult situations and in helping to minimise any risks to people’s safety. Toilet doors in the unit for people with enduring mental health problems should have picture signs to help people with disorientation to find them. This will help to reduce confusion and maintain people’s independence, comfort and dignity. Wheelchairs should be stored in appropriate areas and not in bathrooms where people could be at risk of injury from them. DS0000070662.V362141.R01.S.doc Version 5.2 Page 27 2 OP7 3 OP9 4 OP18 5 OP18 6 OP19 7 OP19 Attlee Court 8 OP33 A review should take place to explore possible underlying issues for the number of safeguarding issues in the unit for people with enduring mental health problems so that any necessary actions can be taken to minimise risks to people’s safety. Attlee Court DS0000070662.V362141.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 Attlee Court DS0000070662.V362141.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. 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