Inspection on 06/09/07 for Axbridge Court

This inspection was carried out on 6th September 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 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

Axbridge Court 07/01/09

Axbridge Court 07/06/06

Axbridge Court 12/12/05

Axbridge Court 08/09/05

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Axbridge Court West Street Axbridge Somerset BS26 2AA Lead Inspector Justine Button Unannounced Inspection 6th September 2007 09:30 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 Axbridge Court DS0000064451.V349128.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. Axbridge Court DS0000064451.V349128.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Axbridge Court Address West Street Axbridge Somerset BS26 2AA 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) 01934 733379 axbridge@almondsburycare.com www.almondsburycare.com Almondsbury Care Limited Sandra Mary Crossey Care Home 36 Category(ies) of Old age, not falling within any other category registration, with number (36) of places Axbridge Court DS0000064451.V349128.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is to be registered for 36 nursing beds. Date of last inspection 7th June 2006 Brief Description of the Service: Axbridge Court Nursing Home, formerly the St.Johns Hospital, has been adapted to a two-storey home in the centre of Axbridge, close to the local shops. The home is in shared private grounds and has car parking space. There is a large garden area. The home has a large well appointed communal lounge and dining room. The home has mainly single bedrooms with en-suite facilities. The en-suites enable wheelchair access. There is a passenger lift facility to the first floor. Aids and adaptations have been made to promote mobility in the home. There is a nurse call system through out the home. Health and safety measures include covered radiators and window restrictions. The home is registered to provide nursing care for up to 36 people. Personal care can also be provided within these numbers. The manager is a registered nurse and there is a registered nurse on duty at all times. Axbridge Court was purchased by Almondsbury Care on 23 June 2005. The owners have undertaken a major refurbishment and improvement programme. Axbridge Court DS0000064451.V349128.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Key Inspection was unannounced and took place over one day and was conducted by one inspector, which amounted to about 7.5 hours. There were 34 residents living at the home at the time of this inspection. Since the last inspection a new manager has been registered with CSCI. Prior to the inspection the manager had completed the Annual Quality Assurance Assessment (AQAA) document about the service. Ms Crossey, the manager, was available for the day of the inspection. Records and policies were inspected in the office. Other feedback about the way the home is managed was from surveys and the following surveys were sent out:- 15 Service User (residents) Surveys and 10 were returned. - 15 Relatives and Visitors Comment card and 4 were returned - General Practitioners and health professional Comment cards and no completed forms were returned. The outcome of these comments cards has been reflected in the main body of the report. The comment cards for people living at the home request either a yes or no answer or alternatively give four choices. These choices are always, usually, sometimes or never. Overall the outcome of the feedback forms was positive A tour of the premises took place where a selection of bedrooms and all communal areas were seen. The inspector saw and spoke to a number of people living at the home and relatives during the day of the inspection. During the inspection the inspector observed interactions between staff and residents to be polite and caring. During the day the inspector “case tracked” four people living at the home. This process reviewing the care plan for an identified individual and then visiting the individual throughout the day to compare the assessed needs of the individual with the care and support offered by staff throughout the day. During the inspection a tour of the premises was made and service users were seen and spoken with both in private and in the communal areas of the home. The home was clean, tidy and well maintained. Lunchtime was observed in the dining areas of the home. Records were sampled, these included, staff training, staff recruitment, personal finances, maintenance records care planning and medication. Axbridge Court DS0000064451.V349128.R01.S.doc Version 5.2 Page 6 The current fee levels are available upon request to the home. What the service does well: Prospective residents and their representatives are able to visit the home prior to admission. Resident’s benefit from being assessed by the home before admission to see if it can meet their needs. Residents are able to have visitors at any time and keep links with the local community. Residents are able if they choose to continue to handle their own finances and are able to access their personal records should they wish to do so. Comments received from residents and relatives via surveys and during the inspection included: ‘all the carers are excellent and very hardworking’, ‘the new activities person is excellent ’, ‘and most staff are great’. Residents benefit from safe medication systems at the home. Residents’ benefit from a good choice of wholesome food. Many residents commented on the quality of the food, one said it was ‘excellent’. The gardens are well maintained. The cleanliness of the home was good at this inspection and smelt pleasant. Residents’ rooms are homely and personalised with their favourite items. Residents’ benefit from the aids and adaptations provided at the home to include adjustable beds, mobile hoists and grab rails throughout. Resident’s benefit from staff undertaking their laundry needs. Resident’s benefit from the home’s commitment to enhancing care at the end of life for them and their relatives. Axbridge Court DS0000064451.V349128.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: Feedback was given to the manager at the end of the inspection. A number of issues were raised. Although the care planning system has improved vastly since the last inspection some areas require additional development. This includes ensuring that the plans of care are person centred and specific. Some people who live at the home and/of their relatives are not involved in the development or review of their plan of care. Some people at the home have tissue damage such as pressure ulcers. The care plans and documentation for the treatment and progress of the tissue damage requires development. In addition to the wound charts currently used Axbridge Court DS0000064451.V349128.R01.S.doc Version 5.2 Page 8 staff should be using tracings and photographs of the wounds in order to help in the review of any treatments that are being used. Although the meals and meal time arrangements have improved consideration needs to be given to increasing the range of snacks that are available between meals. Cakes and biscuits are available but these may not be appropriate for all people living at the home for example for those with a swallowing difficulty. A system of staff supervision has not yet been implemented. This needs to be considered in order to ensure that staff feel supported and have the skills to fulfil their job role. The mental capacity act has recently been introduced. The management need to ensure that all documentation and care is delivered in line with this new act. 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. Axbridge Court DS0000064451.V349128.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 Axbridge Court DS0000064451.V349128.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5. (Standard 6 does not apply) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The statement of purpose and service user guide are reflective of the care and support offered at the home and the managerial arrangements All prospective residents receive a pre admission assessment by the registered manager or senior nurse to ensure the home can meet the assessed needs identified. All people living at the home have a copy of the terms and conditions of their stay. EVIDENCE: Axbridge Court DS0000064451.V349128.R01.S.doc Version 5.2 Page 11 The Home provides a Statement of Purpose that clearly sets out the objectives and philosophy of the Home and also includes a resident guide, which provides additional information about the Home. The Statement of Purpose contains details about what the prospective resident can expect and gives an account of the quality of the accommodation, qualifications and experience of staff, how to make a complaint and recent CSCI inspection findings. All residents are given a copy of the Statement of Purpose, which is kept in their bedrooms. This ensures that information is always available for reference. Clear information about contracts/terms and conditions, fees and extra charges is available in the Home’s Residents Contract. Each resident is provided with, and asked to sign, a residents contract prior to moving to the home and they retain one copy. All the people who returned surveys prior to the inspection stated that they had received a copy of the terms and conditions. The contract details the room to be occupied. There is a four weeks trail period for all parties at the beginning of occupancy. The fee levels seen ranged from £360 to £560 per week. This did not include the Registered Nurse Care Contribution (RNCC) All new residents receive a full comprehensive needs assessment before admission. The preadmission assessment ensures all parties are happy that the home can meet any assessed need prior to the individual moving to the home. The assessment is completed by one of the senior staff at the home. People who are considering moving to Axbridge court and/or their relatives are able to visit and view the home prior to moving in. Axbridge Court DS0000064451.V349128.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 adequate. This judgement has been made using available evidence including a visit to this service. Care planning practice was adequate to enable a satisfactory standard of care to be given. Some development is required to ensure that the plans are person centred and with regard to pressure ulcer documentation. Evidence was seen of input from the resident and/or their representative in some but not all cases. Care plans were stored in line with Data Protection. The management of medication within the home was generally good. Residents are able to have privacy in their own rooms. Personal support was offered in a way to promote the privacy and dignity of residents. Service users were treated with respect. Axbridge Court DS0000064451.V349128.R01.S.doc Version 5.2 Page 13 EVIDENCE: The Feedback forms asked people living at the home • Do you receive the care and support you need? 8 stated always and 2 stated usually. • Do you receive the medical support you need ? 7 stated always and 3 stated usually Two comments on the forms stated that they were more than happy with the care and support received. Three individual residents care plans were assessed and the residents met as part of the case tracking process. In addition a further two care and support plans were viewed. Care plans contained up to date assessments, which included moving and handling, reducing the risk of pressure sores & falls. Care plans are then developed for any assessed needs. Some of the plans were slightly ambiguous containing comments such as “ensure adequate fluids” and “ensure adequate diet” Staff need to ensure that comments made in the assessments and care plans are detailed and specific. They should give clear instructions to the care staff. One individual at the home had recently had a hospital admission and had returned to the home with some increased needs. The plan had not been reviewed to reflect these changes. Another individual had had some recent weight loss and had been identified in the nutritional assessment as being at very high risk. A plan of care had not been implemented for this identified need. For another individual however weight loss had again been identified. For this individual advice had been sought from the GP and dietician. The advice gained form these individuals had been incorporated into a plan of care. It was observed during the inspection that staff followed this plan of care during the day. The plans reflect the homes move to a person centred approach. Likes and dislikes were well documented in some of the plans seen but not in others. Some of the plans did not have input from the individual or their representative in the development or review of the plan. Involving the individual in the development and review of their plan of care would enhance the individuality of the plans and ensure that they are truly person centred. The management need to ensure that the care plans are completed consistently to the same standard. Some people at the home have pressure ulcers or wounds. Plans of care had been developed for these however these need to be developed. Photographs and tracings are not currently used. Tools such as these can help in assessing the progress of the wound and ensure that the correct treatment is being given. Staff need to develop the use of photographs and tracing along with the current wound charts. Axbridge Court DS0000064451.V349128.R01.S.doc Version 5.2 Page 14 A percentage of people living at the home are frail and as such were nursed in bed during the inspection. People nursed in bed or those at risk of the development of pressure ulcer had a regular change of position. People who are unable to move freely or have mobility issues need to support by staff to change position regularly. This was seen to be completed by staff in line with the assessed need and the care plan. All people seen during the inspection including those nursed in bed had access to fluids. For those who were frail staff had implemented positional and fluid charts. These were seen to reflect the care given throughout the day. The home has recently recruited a physiotherapist who attends the home on a weekly basis. People spoken to during the inspection stated that they appreciated this service. The care plans seen confirmed that people living at the home have access to a range of health care professionals. This included input from district nurses, GP’s, Social workers & palliative care specialists. The medication records were assessed and best practice was noted for the most part. The home uses the monitored dosage system (MDS) with preprinted medication administration records (MAR). The registered nurse on duty administers medicines. All medication was stored in line with good practise guidelines. The documentation of medication including control pain relief was viewed. The documentation was of a good standard and a clear audit trail was evident. There was evidence of good recording in the Medication Administration Records, recording of blood sugar and pulse levels, recording of variable doses and all hand trancribed medications were signed by 2 staff to ensure no errors in recording. For one person who requires insulin the “normal” blood and guidelines were in place for action to be taken if the blood sugar was found to be outside this limit. A number of people living at the home are prescribed creams and lotions by the GP. These had been entered onto the MAR although staff had not signed to confirm that these had been applied. Staff demonstrated a good understanding of how to promote privacy and dignity and examples of how they do this were seen. Staff were seen interacting kindly to residents and were seen knocking on doors before entering. Residents spoken to confirmed that staff treated them with respect and helped to maintain their privacy when delivering personal care. Axbridge Court DS0000064451.V349128.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a wide range of opportunities for social stimulation and residents are supported to join in with organised activities or pursue their own interests. Residents are encouraged to maintain links with their families and friends. Visitors are made welcome at the home. Service users are offered a choice of nutritious well-balanced menus promoting their health and well-being. EVIDENCE: In the care plans which were inspected an assessment of social needs was seen in all cases. There is now a dedicated activities organiser in the home, spending 37 hours a week in activity-related work. The plans relating to recreational needs had been reviewed. Records of activities attended were maintained. People who gave an opinion during the inspection said that there were things to do if you wanted. Activities included gardening, arts & crafts, Axbridge Court DS0000064451.V349128.R01.S.doc Version 5.2 Page 16 exercise and one-to-one sessions. During the inspection on day one there was evidence of one-to-one sessions and arts & crafts. Information received from the surveys was very positive. Five replied there was always activities available. Four people said there were ‘usually’ activities to take part in and one person said there ‘sometimes’ were. People spoken to during the inspection were very complimentary about the enthusiasm of the activities organiser. The activities programme is on display in the main hallway of the home. This showed that there was a range of activities on offer including bingo, arts and crafts, crosswords and quizzes and exercises. The home has an open visiting policy and people living at the home confirmed that visitors were welcomed. All residents in their rooms could access a call bell The majority of residents spoken to and in the surveys were very complimentary about the food. They were given a choice of all meals including breakfast. The menus are being reviewed by the chef. This may improve the range of food offered, for example, to include more vegetarian options and fish. The dining room has been refurbished and is now a pleasant room in which to have a meal in. The tables were set with tablecloths, napkins and condiments. People living at the home could stay in their rooms to eat if they wished. Residents are asked each day for their choices for the next day. The menu is on display on each of the tables. People spoken during the inspection stated that they could always ask foe an alternative if they did not like what was offer and that staff would do their best to accommodate their request. The meal served on the day of the inspection looked and smelt appealing. People who required assistance were helped in a dignified and discreet manner. Hot and cold drinks were available between meals and biscuits and/or homemade cake were available. There were no snacks available for people who could not access the cake or biscuit for example for those with a swallowing difficulty. This was discussed on the day of the inspection with the chef. The chef stated that he was aware of specialist diets and needs of the people living at the home. Full fat milk and butter was used for those people who had or were at risk of loosing weight. Milky drinks are also available. The chef agreed to review the snacks available to include fruit, yoghurts and smoothies for example. When asked through surveys about the food provision 6 of the 10 who replied said that they always liked the meals at the home. Two stated usually and two Axbridge Court DS0000064451.V349128.R01.S.doc Version 5.2 Page 17 sometimes. All of those asked on the day of inspection said that the food was good. People’s rooms were seen to be personally decorated and people confirmed that they were able to bring small items af furniture and personal belongings within the scope of the room size. The people using the service confirmed that within reasonable timescales they were able to get up and return to bed at a time of their choice. The home holds regular meeting to which people living at the home and relatives are invited. This gives people the opportunity to influence life at the home. Minutes of these meetings are kept and availble to any interested parties. Axbridge Court DS0000064451.V349128.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home has a complaints procedure which is in line with good practise guidelines. Residents feel able to make a complaint if they are dissatisfied about any aspect of their care. The process is clear. Processes for decision-making according to the Mental Capacity Act (2005) were not always being followed, such that residents rights may not be protected in this respect. The home takes appropriate steps to reduce the risk of harm or abuse to service users. EVIDENCE: The home had a complaints procedure, which was available to service users, staff, and visitors. It forms part of the Service User Guide and is detailed in the Statement of Purpose. Service users who were able and staff spoken with informed the inspectors that they would not hesitate in raising concerns if they had any. All but one resident in seven surveys knew how to make a complaint. Axbridge Court DS0000064451.V349128.R01.S.doc Version 5.2 Page 19 One complaint had been received by the home since the last inspection. This had been investigated appropriately and any necessary action taken, The CSCI have received three complaints against the home since the last inspection. These complaints were in October 2006. During this time the home was going through a period of change including a change of management. No complaints have been received since this time. The home has not had to make any referrals under Safeguarding Adults procedures. Three people using the service and visitors to the home confirmed that they would raise any concerns with the management of the home and felt confident to speak to any staff about any worries they may have.They were confident that any concerns would be dealt with promptly. The feedback forms returned all stated that thye woud be happy to raise any concerns that they had and all were clear of the complaints procedure. Training in recognising and prevent adult abuse is given during induction. Staff who had recently been employed by the home were spoken during the inspection and were aware of the whistleblowing policy. POVAFirst checks had been undertaken before staff had commenced working at the home. See Standard 27 for recruitment practices. In the care records there were aspects which may not comply with the Mental Capacity Act 2005. For example, a relative had signed to indicate that her relative should not be resuscitated and one relative has signed for the use of bed rails For neither of these documents was there evidence of an assessment of capacity, who had been consulted and that any decision of this serious nature had been decided according to the ‘best interests’ criteria for that person. Similarly the use of restraint, for example, in the form of bed rails must comply with the Mental Capacity Act, where the individual lacks capacity to make this decision. Axbridge Court DS0000064451.V349128.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20,21, 22, 23, 24, 25, 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well maintained and has undergone significant upgrading and refurbishment. Residents are able to personalise their rooms with their favourite items and have the specialist equipment required to meet their individual needs, however specialist bathing provided may not meet some individual residents assessed needs. Baths in en-suite facilities had been disabled. Residents have a good choice of pleasant communal areas to sit and socialise in. There is a pleasant accessible garden. All parts of the home were clean and pleasant at the time of this inspection. Infection control measures in place were adequate. Axbridge Court DS0000064451.V349128.R01.S.doc Version 5.2 Page 21 EVIDENCE: The home has recently undergone a period of refurbishment redecoration including the lounge, dining room, halls and corridors, new wet room/shower and refurbishment of the bathrooms, redecoration and recarpeting of many bedrooms and new furniture. These refurbishments have been completed to a high standrd and the home now proovides a pleasant enviroment in which to live. The refurbishment is set to continue over the next 12 months with the remainer of the bedrooms and the kitchen due to be updated. An LCD television has also been installed in the communal lounge. Comments form the relative feedback forms included “the refurbishment to the building are going well. The bathroom and shower rooms are splendid.” Bedrooms are situated on the first and second floor and are accessed by a passenger lift and stairs. There are a number of communal sitting areas throughout the home giving a choice to residents. Corridors are spacious these are fitted with handrails. Many bedroom doors have automatic fire door closures. All bedrooms seen were individual and personalised. The grounds are well maintained, which provides a colourful area in the main front garden. Garden areas are mainly accessible for independent wheelchair users and there are tables and chairs in the paved area. There is adequate provision of hoists, which have been serviced regularly. It was found that a number of people living at the home had been assessed as requiring specialist equipment such as pressure mattresses, pressure mats and adjustable beds. These had been provided. During the assessment of the premise it was noted that all residents could access their call bells to summon assistance. The home was very clean and pleasant on the day of the inspection. Infection Control measures were in place and staff were seen using correct techniques. Alcohol hand gel was available throughout the home. The most recent staff employed by the home told inspectors that they were aware of infection control measures in place. All laundry is washed in house and the laundry facilities were adequate for the numbers and needs of the service user group. Axbridge Court DS0000064451.V349128.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30. Quality in this outcome area is adequate . This judgement has been made using available evidence including a visit to this service. Staffing numbers may not adequate to ensure that all the needs of the current service users are being met at all times. Staff training is not consistent for all and this may mean that staff are not working to the best of their ability and according to safe practice. Recruitment practice was not as robust as it should be and this may put service users at risk of unsuitable people being employed. EVIDENCE: At the time of the start of this inspection there were 34 people living at the home. The manager was on duty in a management role. There was a Registered Nurse (RN) on duty and in charge of the shift from 8-8pm. There were six care staff on duty during the morning. Minimum staffing levels were being met at this time. Five staff are on duty in the afternoon and two at night Axbridge Court DS0000064451.V349128.R01.S.doc Version 5.2 Page 23 Duty rotas were inspected for 2 weeks and these showed that a consistent level of staffing was being maintained. Feedback from residents, relatives and staff question whether staffing levels are adequate. 4 people stated that there were always staff available to help them and 6 service users said there was ‘usually’ staff to help them. Comments included “you sometimes have to wait for help. Information received from the home prior to the inspection demonstrated that the needs of people living at the home are relatively high including 15 people who require help at meal times. The management need to keep the staffing levels under review to ensure the needs of people continue to be met. A dependency tool may be useful in helping to make an objective assessment of need. In addition to the care staff the home employs a number of other staff including kitchen staff, cleaners, activities organiser, administrator and laundry staff. Since the last inspection the home has employed a deputy manager. This has strengthened the management systems within the home. The information received prior to the inspection stated that home employs 16 care staff at the home and 10 of these have either achieved NVQ Level 2 or above or are working towards this. This exceeds 50 as set out in Standard 28. The home uses a system of induction, which meets the Skills for Care standards. No completed records were seen however new staff employed stated that they had completed this induction. The training matrix was viewed during the inspection. The home employs 26 staff. The training matrix showed that 20 staff had attended moving & handling training in May 2007, 13 staff had attended fire training in March 2007. This would indicate that not all staff have received all necessary mandatory training. The management need to review this and ensure that all staff have attended all mandatory training to ensure that the health and safety of people living at the home, staff and visitors is not compromised. Staff spoken to during the inspection stated that they had received additional training. All stated that they felt that they had the skills to meet the needs of people at the home. The training matrix showed that all the kitchen staff had received training in food hygiene. Training for the care staff had included diabetic training, which was conducted in March 2007. 12 staff had attended this training. Training had been planned on the use of syringe drivers in September 2007. Three staff recruitment files were examined. These contained all appropriate information as required in Schedule 2 of the Care Homes Regulations 2001. Enhanced CRB checks and POVA checks were in place. Axbridge Court DS0000064451.V349128.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, 37, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are benefiting from an experienced and knowledgeable manager. The manager is striving to implement a person centred approach to meeting the social care needs of the residents therefore enabling equality and diversity. Residents have an opportunity to manage their own finances if they wish and facilities are provided for security. Where the home manages money on residents’ behalf a system is in place to record all transactions Residents are protected by the health and safety checks in place. Axbridge Court DS0000064451.V349128.R01.S.doc Version 5.2 Page 25 EVIDENCE: The manager, appointed since the last key inspection has completed the registration process with CSCI. She is a registered nurse with experience in different care settings. There is an area Manager for the company and they supports the manager and the home. The manager operates an ‘open door’ policy and welcomes feedback from service users, staff and relatives. All feedback about the manager was that she is approachable and open and is helping to make improvements in the home. Regular staff meeting are held and minutes are kept of these meetings. Quality monitoring systems and policies were in place. A questionnaire are sent out to service users. The results are collated and use to review the care and support offered. Finances kept on behalf on residents by the home were sampled and good practise was observed. Records of all transactions are maintained and two staff always sign as witnesses to transactions. All receipts are kept. A certificate showing up to date insurance was on display. Staff supervision is planned but has not been fully implemented. The manager stated that she is hoping to fully implement the system in the near future. The lack of supervision may mean that staff do not feel they have enough support in the workplace to enable them to work to the best of their ability. Also, if their practice is not monitored they may not be working according to company polices and procedures. All health and safety checks were in place and up to date. The maintenance person is commended for the safety check records he has maintained. These include fire equipment checks and checks of bed rails. Accidents records were maintained. Staff accidents were recorded. See section on staffing for staff training on mandatory training, including, moving & handling, fire awareness. A representative of the registered provider is required to visit each month and keep a record. These reports are made available to the CSCI. Axbridge Court DS0000064451.V349128.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 3 3 3 X 3 3 3 Axbridge Court DS0000064451.V349128.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP30 Regulation 12 (1) Requirement It is required that all staff receive all mandatory training to include, Moving and handling and fire training Timescale for action 30/11/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations It is recommended that all service users and/or their representatives are involved in the development and review of the plans. It is recommended that the management review the care plans to ensure that they are consistently completed and that they reflect all the care needs of the people living at the home. It is recommended that the use of tracings and photographs are used to supplement the current wound charts. It is recommended that the range of snacks available living at the home to ensure that they are accessible to all people at the home. DS0000064451.V349128.R01.S.doc Version 5.2 Page 28 2. OP7 3. 4. OP7 OP15 Axbridge Court 5. OP36 It is recommended that a system of staff supervision is implemented Axbridge Court DS0000064451.V349128.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Taunton Local Office Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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. 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