Inspection on 03/01/08 for Belong Macclesfield

This inspection was carried out on 3rd January 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

Belong Macclesfield 05/01/09

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Belong Macclesfield Kennedy Avenue Macclesfield SK10 3DE Lead Inspector Bronwyn Kelly Unannounced Inspection 3 January 2008 10:00 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 Belong Macclesfield DS0000070473.V352094.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. Belong Macclesfield DS0000070473.V352094.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Belong Macclesfield Address Kennedy Avenue Macclesfield SK10 3DE 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) 01625 508700 christine.hiley@clsgroup.org.uk www.clsgroup.org.uk CLS Care Services Limited Mrs Christine Hiley Care Home 72 Category(ies) of Dementia (37), Old age, not falling within any registration, with number other category (35) of places Belong Macclesfield DS0000070473.V352094.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only. Care home with Nursing - code N, to people 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. The maximum number of people who can be accommodated is: 72 Date of last inspection This is the first inspection. Brief Description of the Service: Belong is a newly registered care home providing personal care and accommodation for 72 older people with a range of needs. Some are traditional residential places, some are for people with dementia, some for those with nursing needs and some are used for intermediate care. This when people are admitted from hospital or home for a period of up to six weeks to undergo some rehabilitation to enable them to live independently at home again. The home is managed by CLS Care Services Limited, a not for profit organisation which manages a number of homes in the Northwest. On site are also a number of sheltered accommodation flats, which can either be purchased or rented. Belong is situated in the outskirts of Macclesfield in a well - established residential area. Local community amenities such as shops, a pub and a bus stop are within a short walking distance. Belong has been built in the style of a village, with households which can be re-configured according to the needs of the community. The design has been carefully planned, and many new technological features have been incorporated. There are six ‘households’ of either 11 or 13 people, each with their own lounge, dining room and fully fitted kitchen which are well furnished, bright and Belong Macclesfield DS0000070473.V352094.R01.S.doc Version 5.2 Page 5 spacious. Each single bedroom has an ensuite shower room with toilet. Shared areas include a bistro restaurant, which is also open to visitors and the public. The lounge/dining areas have either a patio or balcony, and there are pleasant secure gardens and walkways with outdoor furniture. The current weekly fees range from £560 - £730. Further details regarding fees are available from the manager. Additional charges are made for newspapers, hairdressing and toiletries, optical and chiropody. People who are interested in moving into the home are able to read the latest CSCI inspection report, which will be available in a copy of the Service User Guide in reception and various parts of the home. Other information about the home and CLS is available in reception. These outline the lifestyle that people can expect when they move into the home. Belong Macclesfield DS0000070473.V352094.R01.S.doc Version 5.2 Page 6 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. An unannounced visit by two inspectors took place on 3 January 2008 and lasted 6.5 hours. This visit was just one part of the inspection. Before the visit, the home manager was asked to complete a questionnaire to provide up to date information about services in the home. CSCI questionnaires were also made available for people who live in the home, families, and health and social care professionals such as doctors, nurses and social workers to find out their views. Other information received by CSCI was also reviewed. During the visit, various records and the premises were looked at. A number of people who live in the home, staff, relatives and visiting professionals were also spoken with. They gave their views about the service, and these have been included in the report. What the service does well: Belong in Macclesfield provides excellent accommodation for the people living there. It is spacious, modern and well equipped with the latest technology to assist people in their daily lives. This means that people live in a comfortable home that is appropriate to their needs. Some relatives we spoke with said they were very happy with the care, and one said, “Staff are very patient with him. He is well looked after and nothing is too much trouble.” Another relative said she is “very pleased with the care.” We also spoke with some people that live in the home, and received some positive comments regarding their new life in Belong. Opportunities for activities and socialising are being developed with the people who live in the home. This means they have more choices available to them regarding their lifestyle. People told us they enjoyed the food and the choices available at each meal, which means that they get a varied and healthy diet. There are opportunities for staff to attend training courses, which means people are cared for by a competent staff group. Belong Macclesfield DS0000070473.V352094.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: Although Belong has been given a rating of adequate following this inspection, this has often been due to the fact that the home is very new, and many of the policies, procedures, and ways of working have not yet become fully operational. Many procedures are still changing from when the home first opened, in order to suit the needs of the people that live there and achieve the best possible outcome for them. The staffing situation is changing all the time and staff are getting used to new ways of working. Many new staff are still undergoing induction training and getting to know the rest of the staff and people that live in the home. However, we felt there was good capacity for improvement over the next year. Some work regarding the storage, administration and recording of medicines is needed to ensure people receive their medication safely and as prescribed by the GP. Use of bedrails in the nursing households should be subject to a risk assessment and covers provided if necessary to ensure the safety of people using them. Some further training for staff caring for people staying in the intermediate care household would improve the outcomes for people who are working towards returning to their own home. Peoples’ life plans and risk assessments should be reviewed regularly and reflect any changing need. This is so that staff always have up to date information about the care to be given to people. A photograph should also be available in the building of each person living in Belong. The complaints procedure should be more visible for people who wish to make a formal complaint rather than a comment. The staff rotas and ways of working should be closely monitored during this settling in phase. This is to ensure there is consistently enough staff available to meet the needs of the people who live in the home. Two of the surveys we received from relatives expressed concern about the numbers of staff on duty. Whilst there is no handyman for the home, alternative safe checking systems must be in place to ensure the health and safety of people in the home. All Belong Macclesfield DS0000070473.V352094.R01.S.doc Version 5.2 Page 8 people working in the home must also be aware of the fire drill procedures, to ensure the safety of people living in the home. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Belong Macclesfield DS0000070473.V352094.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 Belong Macclesfield DS0000070473.V352094.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 and 6. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Peoples’ needs are assessed in a variety of ways before they move into Belong, so that they, their relatives and staff at the home know that these needs can be met when people move in. However, some of the paperwork used for the assessment could be improved so that staff have all the information they need to care for people. EVIDENCE: Written assessments for people wishing to move into the various households of the home (Oak, Poplar, Beech, Cedar and Holly Houses) are provided by health and social care professionals to give the staff information about those people’s care needs. Discussions also take place with the family and the person’s social worker, if they have one. The manager or a senior member of the staff visit each prospective resident in their own home or hospital and carry out a full assessment, to ensure their needs can be met at the home and that staff have the skills and ability to meet these assessed needs. Four completed assessments were seen on care plans in Poplar, Beech and Cedar houses, Belong Macclesfield DS0000070473.V352094.R01.S.doc Version 5.2 Page 11 although one seen was not dated or signed. When people move into the home, the information from the assessments is used to develop a plan of care, which is called a Life Plan in Belong. Willow House is an intermediate care unit for up to eleven people, which has a rehabilitation function to enable people to recover enough to return to their own home. There is also input from physiotherapists and occupational therapists provided by the Primary Care Trust. People are admitted from hospital or from their own home via the rapid response team. The home’s staff do not carry out an assessment before people move in; however information about the person, and what their needs are, is faxed to the home before they go to stay at the home. The manager said that she has found it necessary to refuse admission when she considered that the home would not be able to meet the needs of an individual. People move in for intermediate care for a maximum time of six weeks. The standard of documentation on the intermediate care household was poor. This means that staff may not have all the information they need about each person’s needs and the support that they require to regain their independence. Assessments were not always completed. Some were completed but not signed or dated. The manager was aware of this problem and it was being addressed in conjunction with the Primary Care Trust staff, who visit very regularly to review the progress of the people living in Willow House. Support staff said that they now have a handover at the beginning of each shift and a communication book is now used, which is helping improve communication Two of the support staff spoken with said that they had chosen to work on the intermediate care household and enjoyed seeing people returning to their own homes. Although all staff have received induction training, the support workers on the intermediate care unit should receive specialist training about rehabilitation so that they can help people to achieve optimum independence and return back to their own homes. There is a registered nurse on duty at all times but she also has responsibility for some people living in Oak household, which is a combined nursing and residential household on the same floor. This situation needs to be monitored to ensure that the nurse has enough time to spend with people who have a high level of need. Two people who live in the home we spoke with thought that they would be able to control their own medication if they had the right support. There was no evidence of a risk assessment to determine whether it would be safe for them to administer their own medication. The manager stated, in paperwork sent to us before the inspection, that “Residents who are capable and request they administer their own medication are involved in an assessment to identify risk and have individual lockable facilities within their own bedrooms to ensure compliance of safe storage”. This is not being carried out. The manager was Belong Macclesfield DS0000070473.V352094.R01.S.doc Version 5.2 Page 12 aware of this issue and was awaiting guidance from the PCT. A copy of the service user guide and statement of purpose were to be displayed at various points around the home, providing information about Belong and the type of lifestyle that people can expect. Belong Macclesfield DS0000070473.V352094.R01.S.doc Version 5.2 Page 13 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. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is some variable practice in the planning and delivery of care which means that some people cannot be sure that all their health and personal care needs are met. EVIDENCE: People living in the nursing households each have a Life Plan and a daily diary. This documentation is still under development; examples looked at on Oak House had not been completed in full and were not kept up to date. There were no photographs for identification of people living in either Oak or Willow houses. For one person who was looked after in bed, the life plan had been completed in October 2007, but there were no reviews since then. Assessments in the life plan were often not signed or dated. Risk assessments for pressure sores, falls and nutrition were completed once (undated) but not reviewed. One person had no weight recorded since October 2007. Belong Macclesfield DS0000070473.V352094.R01.S.doc Version 5.2 Page 14 One person required twice daily insulin. A chart had instructions for his blood sugar to be tested daily but there was no record of this being done on the 1 and 2 January 2008. A number of people had bedrails in use. The bedrails did not have protective covers and the rails are a sufficient distance apart for a limb to be trapped. The risk assessment for the use of bedrails did not address this. Peoples’ medicines are kept in their bedrooms and storage arrangements were not secure enough. The manager commented that they were having some problems with the medication system and was asked to put into place a system that was more secure. Meanwhile, we have asked a CSCI pharmacy inspector to visit the home and offer advice. A nurse was giving out medicines on Willows and Oak houses. She said that she was constantly interrupted while doing medicines and was still giving out morning medicines at midday. Two boxes of hypodermic needles were found in an unlocked wardrobe in an unoccupied bedroom. Handwritten medicine administration record sheets on Willow House did not have the quantity of medicines received recorded on them so it is not possible to check whether the balance is correct. Controlled drugs for one person had not been checked in and they were stored in a plastic bag full of other medicines. These were in the wardrobe, not in the metal cupboard. They are not recorded anywhere. Two of the medicines for one person were written on the record sheet as PRN (to be given when needed). There was no guidance as to under what circumstances they should be given and no guidance on how often they could be given or the maximum safe dose in 24 hours. The manager is aware of the problems with the medication system and has met with the local pharmacist recently to try and resolve some of these. One person said that she would prefer to look after her own medicines. There was no record of an assessment being carried out to show whether she was able to do this. A number of relatives visited Cedar House during the inspection. The relatives of one person living in the unit told us, “Staff are very patient with him. He is well looked after and nothing is too much trouble.” Another relative said she is “very pleased with the care.” These comments were in contrast to others received in questionnaires from some relatives before the inspection, who were unhappy with a number of aspects of their relatives’ care. CLS is currently dealing with this. One person living in Poplar House told us, “Very nice. Staff are very good. You ring the bell and they come right away. Meals are very good – well Belong Macclesfield DS0000070473.V352094.R01.S.doc Version 5.2 Page 15 cooked. Very caring staff”. However, this person went on to explain that he felt ‘locked in’ the household as he could not leave without the assistance of staff to visit any of the other facilities in the building. Paperwork on Poplar, Beech, Cedar and Holly houses was varied in quality. There was very little information in the life plan about the care needs of a person who had moved in just before Christmas. Some other paperwork was only partially completed, often without being signed or dated. There was very little evidence of any reviews of the life plans, even for people who had lived in the home since it opened, and no-one has focused on whether or not the life plans are still effective to make sure people’s needs were being met. This means that staff may not have up to date information about each person’s care needs. However, some life plans were excellent and written in a person centred way, sometimes by the family in conjunction with the resident. They clearly spelt out how people were to be encouraged to make their own decisions and choices. Belong Macclesfield DS0000070473.V352094.R01.S.doc Version 5.2 Page 16 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live in the home have the opportunity to choose their preferred lifestyle and food, and choose from a range of activities so they retain control over their lives. EVIDENCE: The home provides excellent facilities for people to enjoy social and recreational activities. Communal facilities include a bistro restaurant, a hairdressing salon and nail bar, a gymnasium and a large, well-equipped activities/meeting room, which includes a cinema screen. There are also safe outdoor garden and patio areas, with chairs and tables for use in the warmer weather. Visitors are encouraged to use the bistro and have a meal with residents whilst visiting. Many residents need the support of staff or visitors in order to be able to make use of these facilities. An activities facilitator is employed but was off sick on the day of the inspection visit. The gym is not yet in use, but will be when staff have completed the necessary training. The hairdressing salon is only available two days a week at present, and the manager is working towards increasing this to a daily basis so that everyone Belong Macclesfield DS0000070473.V352094.R01.S.doc Version 5.2 Page 17 who wishes to can have an appointment. Beauty and therapy treatments are also offered but not yet widely available. In information sent to us before the inspection, the manager wrote, “We have a dedicated activities facilitator who encourages residents to become actively involved in setting up the programme of activities within Belong”. She also wrote, “We introduce people to Belong and try to ensure that it is a change of address not a change of lifestyle. We encourage individuals to maintain their links with their local community”. There are shops and a pub across the road from the home. A visitor had brought a dog to visit one of the residents. The daily menus provide a good choice of food for people. Support staff make breakfast and lunch on the individual households at a time to suit the people who live in the home. Fridges and cupboards on the residential units were well stocked with a variety of food, and residents could choose what they wanted to eat. Fresh homemade soup was sent from the main kitchen every day to supplement the household stock of food. One resident said that if staff are busy, or if the home is short-staffed, then there are only sandwiches at lunchtime: however on the day of the inspection, staff were seen to be making different meals for people and one was cooking bacon. The majority of staff have completed food hygiene training. The evening meal is the main meal of the day and provided from the main kitchen in heated trolleys. Staff ask residents each morning what they would prefer - there is a dish of the day then approximately 10 other choices of main meal. Fresh fruit was seen in the households. A number of people told us that the food is excellent, and relatives said the same in questionnaires. Belong Macclesfield DS0000070473.V352094.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 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements for making complaints and protecting people who live in the home from abuse are satisfactory, so people are not at risk from harm or poor practice. EVIDENCE: In paperwork sent to us before the inspection, the manager wrote, “The management team have an open door policy which means they are accessible to residents and relatives on a day to day basis. Contact is maintained on a daily basis to encourage feedback at a direct level. I feel we value and empower people to speak out and voice their opinions or tell us if they are not happy.” CLS encourages people who live in the home and visitors to express any comments they have about the service provided, and comment cards are on display in main entrance. The complaints procedure is available in the service user’s guide and a copy of this is kept in a number of areas around the home. However, one relative commented, “I have asked about the complaints system but staff on reception were unable to supply information. There is a feedback form.” Some people are therefore not aware that the complaints procedure is in the service user guide. The complaints procedure should be clearly displayed throughout the service and available in a variety of formats where required. Belong Macclesfield DS0000070473.V352094.R01.S.doc Version 5.2 Page 19 There is a full record of complaints received, which to date have been four, and the outcomes. There is a ‘speaking out at work’ policy which encourages staff to raise any concerns they may have openly. Discussions with people who live in the home confirmed that they know who to speak to if they are unhappy with anything. The manager is planning regular meetings with people who live in the home, which is another way in which they can express any concerns or make suggestions. The manager told us, ”We always take complaints seriously and use it to improve our service rather than look on it as a negative in relation to the service provided.” The home has thorough adult protection procedures which link in with the local authority to protect people that live in the home. Training is provided to staff on this policy, and there is evidence that staff have an understanding of the action to be taken if an allegation or incident occurs. Belong Macclesfield DS0000070473.V352094.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 and 26. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The facilities and equipment provided for people living in Belong are excellent, which means that people live in a safe, comfortable and well-designed home that meets their needs. EVIDENCE: Belong in Macclesfield has been built in the style of a village with various flats and households that cater for a wide range of physical and mental health needs, which can be re-configured according to the needs of the community. The design has been carefully planned, and many new technological features have been incorporated. There are six ‘households’ of either 11 or 13 people, each with their own lounge, dining room and fully fitted kitchen which are well furnished, bright and spacious. People who live in the home can participate in the preparation Belong Macclesfield DS0000070473.V352094.R01.S.doc Version 5.2 Page 21 of their own meals and drinks. The lounges have a balcony or patio so that fresh air is easily accessible for people. One concern we had, which was also mentioned to us by someone that lives in one of the households was that the main doors into the household are locked, and staff use electronic ‘fobs’ to release the lock if they want to get out. Whilst this may provide safety and security on households where people with dementia live, it is not appropriate on residential households. Each bedroom has an en-suite shower with shower chair, toilet and washbasin. There is also a bathroom for each household with an adjustable bath and a fixed hoist. This provides people with a choice of bathing facilities. Bedrooms seen were very well furnished, providing comfortable, homely and spacious accommodation. People are encouraged to bring belongings from home when they move in, and furniture is also welcomed. One person has brought in a pet cat to live in his bedroom. There are a number of secure patio/garden areas with well planned walkways and outdoor chairs and tables for use in the warmer weather. There is a fully equipped hairdressing salon and nail/beauty bar. In the entrance to the home there is a large bistro/restaurant, which is open to people who live in the home, relatives, visitors and the general public. People who live in the flats may also purchase a meal there. People who live in the home may choose to have a meal here rather than in their household. The home was in excellent order throughout. There are staff whose role is to clean the shared areas of the home and the two nursing units, but in the residential households, support staff have a dual role of care and housekeeping duties and some are unhappy about this. Although all areas looked clean at the time of the inspection, some staff said that if they were busy, or shortstaffed, then cleaning work could not always be done. Infection control issues around staff helping people with personal hygiene then preparing meals for others need to be carefully managed. Belong Macclesfield DS0000070473.V352094.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 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although there are some staff difficulties in relation to new roles, staff have had training to help them develop their skills and provide safe care to people that live in the home. Recruitment procedures are thorough enough to ensure that people are protected. EVIDENCE: In paperwork sent to us before the inspection, the manager wrote, “At Belong we have a new staffing structure which includes a General Manager, a Support Manager, a Front of House Manager, RGNs, Senior Support workers, Support workers, Assistant support workers, Housekeeping, Catering, Administration and Reception. We have a mixed staff group comprising of people with a wide range of experience and knowledge that they can pass on to those newer staff who have recently become new members of our team. We have gone through a very long process of recruitment and selection in preperation of our home opening. This is due to the additional staff numbers we need to meet the Belong Village concept. All the staff have gone through a selection process ensuring that we have a blend of experience, skills and personality to meet the needs of each household and the residents who live on Belong Macclesfield DS0000070473.V352094.R01.S.doc Version 5.2 Page 23 them.” During the inspection, the manager told us that she has been trying a number of different ways to staff the households. One problem has been lack of leadership within each household. One staff member tolds us “there is no senior on duty to ensure people are doing their jobs properly”. The manager is aware of this and is planning to have a senior support worker on each household for each shift. There are also plans to develop a key worker system, which will enable staff to meet the individual needs of people in a better and person-centred way. Staffing rotas are still under development and new ways of working are being tried to meet the needs of people that live in the home. The manager is aware of the difficulties at present, and is receiving support from CLS management to try and resolve these. However, the staff on duty told us they were unhappy with their dual function of care and cleaning, saying they had little time to spend talking with people that live in the home. Although their role was to encourage people who live in the home to be involved in the running of the household, they said in practice this did not happen as people required too much care. Five nurses are employed in the home to work in the two nursing households, with one on duty each shift. In addition, there are two support staff working on each household, with an assistant support worker available during busy times such as mornings. At night, there is one nurse and six support staff in the home. A number of concerns regarding staffing were raised in some of the surveys sent to relatives before the inspection. Some comments were “–“I find the care here inconsistent – sometimes good and at other times not so. Sometimes they seem short staffed.” Another wrote, in answer to ‘How can the home improve, - “More staff to carry out what was promised when the place was opened – the core values. I feel with more staff the place would be wonderful for everyone involved.” It will be necessary to continually monitor the staffing levels in the future to ensure there are sufficient to meet all the needs of the people living in the home. The staffing structure at present has been designed to meet the needs of the people who live in the home rather than led by staff requirements – this is good practice, but will only succeed if there are sufficient staff employed. The staffing situation is changing all the time and staff are getting used to new ways of working. Many new staff are still undergoing induction training and getting to know the rest of the staff and people that live in the home. Some of the staff are finding it difficult to adapt to new methods of working and there was clearly some discontent amongst the team. Belong Macclesfield DS0000070473.V352094.R01.S.doc Version 5.2 Page 24 Staff training is encouraged and the majority have completed statutory training such as moving and handling, first aid and adult protection. Some need to update their training, and plans are underway for this including the collation of a staff development plan. The manager also told us that many staff have undertaken a 5-day training course about care of people with dementia. Paperwork sent to us before the inspection detailed other training available to staff that was geared to meet the individual needs of people in a person centred way. Staff are also encouraged and supported to achieve NVQ qualifications in caring and progress their career by attending training outside the organisation. This will benefit the individual, the organisation and provide improved outcomes for people that live in the home. To date, 31 of support staff have achieved a minimum of NVQ level 2 and a number of staff are working towards their qualification. Many of the housekeeping staff have completed or are working towards NVQ in housekeeping. There are housekeeping staff for core areas of the home 7 days a week – days and evenings. They can be called upon for specialisr help if there is an accident or spillage in one of the households. Good policies and procedures are in place for recruiting staff. Four staff files were seen and each contained evidence of an interview, two references and the necessary POVA and CRB checks having been obtained before the staff member started working in the home. This provides a level of security and safety for people that live in the home and helps to protect them from possible harm. All staff have an induction according to their role, and staff spoken with confirmed this. Belong Macclesfield DS0000070473.V352094.R01.S.doc Version 5.2 Page 25 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Although Belong is a new service and is not yet fully operational, with a number of issues to be addressed, there is evidence that there is good capacity to improve over the coming year, providing better outcomes for people who live in the home. EVIDENCE: The registered manager is very well experienced and qualified to run the home and is competent to meet its stated aims and objectives. She is able to describe a clear vision for the home based on best practice and CLS’s values. The way the home is run shows a good understanding of person-centred thinking and equality and diversity. The service is still very new and the manager was clearly aware of issues that need to be addressed. There is Belong Macclesfield DS0000070473.V352094.R01.S.doc Version 5.2 Page 26 evidence of good capacity to improve. She said that she is receiving good support from senior management of CLS. The front of house manager is also well qualified and experienced and her role is to head up housekeeping, catering, activities, reception, hairdresser, maintenance, administration and finance. There are good policies and procedures for the home. Not all staff are receiving staff supervision regularly to ensure they adhere to these, although this is in the process of being developed. A CLS quality assurance monitoring system is in place and there are plans to distribute quality questionnaires to people who live in the home and relatives in the near future. The home works to a satisfactory system for safeguarding peoples’ money and clear records with receipts are kept. Policies and procedures for safeguarding residents’ money provide security. There are good health and safety policies and procedures for the home. Maintenance contracts are in place for equipment and installation that require regular servicing. However, regular in-house maintenance checks such as hot water temperatures and emergency lighting tests are not being carried out, as there is no handyman in post at present. One member of the support staff spoken with was from an agency, and was working in the home for his second day. Discussions showed that he had not been told what to do in the event of the fire bells sounding. Belong Macclesfield DS0000070473.V352094.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X 2 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 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 2 17 X 18 3 4 X X X X X X 4 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Belong Macclesfield DS0000070473.V352094.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? N/A Belong Macclesfield DS0000070473.V352094.R01.S.doc Version 5.2 Page 29 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 OP8 Regulation 13(4)(c) Requirement Risk assessments for the use of bedrails must be in place so that people are cared for safely in bed. Suitable arrangements must be put into place for the secure storage of medicines and medicine keys must only be available to staff who are competent to administer medicines. This is to ensure the safety of people that live in the home. Controlled drugs must always be stored according to the requirements of the Misuse of Drugs Act 1971 for the safety of people that live in the home. There must be a record of all medicines that are brought into the home and the quantities. This is so there is an audit trail of all medicines that pass through the home. When printed instructions are not provided with medicines, staff must handwrite all the details from the medicine label onto the record sheet, which must be checked by a second person, and then both sign the record. This is so that staff have clear instructions how to give residents their medicines so they receive them safely as prescribed by their GP. DS0000070473.V352094.R01.S.doc Timescale for action 25/02/08 2 OP9 13(2) 25/02/08 3 OP9 13(2) 25/02/08 4 OP9 17(1)(a) Schedule 3(3)(i) 25/02/08 5 OP9 13(2) 25/02/08 Belong Macclesfield Version 5.2 Page 30 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP6 Good Practice Recommendations Staff caring for people in the intermediate care unit should receive specialist training in rehabilitation so that people are enabled to maximise their independence and return home. Peoples’ life plans and risk assessments should be reviewed regularly and reflect any changing need. This is so that staff always have up to date information about the care to be given to people. A photograph of each person who lives in the home should be available for safety and recognition. For people who wish to look after their own medicines, a written risk assessment should be carried out that is regularly reviewed. This is important as it allows them to maintain some independence and receive the right level of support from staff and to ensure the medicines are not mishandled. The complaints procedure should be made more visible and available for people that live in the home, relatives and visitors, as the comment cards do not provide enough information for people who wish to make a formal complaint. The staff rotas should be closely monitored to ensure there are consistently enough staff available to meet the needs of the people who live in the home, with more staff being available at peak times of activity. Any agency staff working in the home must receive training in fire safety before they start work so that they understand and know how to implement the fire safety procedure. The manager should ensure there are systems in place to maintain a safe environment in the absence of a handyman, to ensure the health and safety of people who live in the home, staff and visitors. 2 OP7 3 4 OP7 OP9 5 OP16 6 OP27 7 OP38 8 OP38 Belong Macclesfield DS0000070473.V352094.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Northwest Regional Contact Team Unit 1, 3rd Floor Tustin Court Port Way Preston PR2 2YQ 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 Belong Macclesfield DS0000070473.V352094.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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