Inspection on 13/11/06 for Bramble House

This inspection was carried out on 13th November 2006.

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

Other inspections for this house

Bramble House 17/09/09

Bramble House 17/09/08

Bramble House 20/09/07

Bramble House 19/06/06

Bramble House 25/10/05

Bramble House 25/04/05

Bramble House 26/10/04

Bramble House 02/06/04

Bramble House 16/12/03

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

CARE HOMES FOR OLDER PEOPLE Acefield Care Home 96a & 98 Stroud Road Gloucester Glos GL1 5AJ Lead Inspector Mrs Janet Griffiths Key Unannounced Inspection 13th November 2006 10.30 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 Acefield Care Home DS0000016357.V317767.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. Acefield Care Home DS0000016357.V317767.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Acefield Care Home Address 96a & 98 Stroud Road Gloucester Glos GL1 5AJ 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) 01452 521018 Forestglade Limited Mrs Vivian Dawn Grimes Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30), Physical disability over 65 years of age (2) of places Acefield Care Home DS0000016357.V317767.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th June 2006 Brief Description of the Service: Acefield Residential Care Home is situated on the outskirts of the city of Gloucester and is within easy walking distance of a local shopping complex. A major building project, completed last year, has joined the large detached house and an adjacent house via a link corridor. The first floor of the main house is accessed either by stairs, a shaft lift or a stair lift. In addition to the above work, by constructing a conservatory and improving the existing lounge/diner, the communal space has been increased. A small quiet lounge is currently being used by the activities co-ordinator and will be used for one to one activities and as a quiet room. With another extension at the rear of the building, the home is now registered to accommodate 30 elderly service users. This extension consists of four single en-suite rooms, new office space and an assisted bathroom. To complete this work, the kitchen has been enlarged and totally refurbished and a new laundry, sluice and shower room have been built. The area that was previously the adjacent house has also been refurbished and extended to provide two extra bedrooms, one en-suite, an assisted bathroom and toilet and the small activities/quiet lounge. Access to the first floor in this half of the building is via a stair lift. There are four assisted baths and a shower within the home and there are now fourteen rooms with en-suite facilities. The home still has extensive gardens at the rear of the building and adjacent to the conservatory, with orchards, vines and fruit that the cook is able to utilise. Additional carparking space has been created at the front of the building. Information about the service to include CSCI reports is made available by the provider to prospective service users through the homes’ Statement of Purpose and Service Users Guide. At the time of inspection the fees are from £333.60 for low dependency and £400.50 for high dependency. Chiropody, hairdressing and newspapers are charged for extra. Acefield Care Home DS0000016357.V317767.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. This unannounced key inspection site visit took place over two days in November 2006, over 8 hours. During this time the inspector spoke to a number of residents, one relative, the manager, deputy manager and staff onduty. Six resident’s files were looked at in detail to include their medication records. Surveys were left with the manager to distribute to the residents or their relatives and to the staff to complete at their convenience. On receipt of these the results will be collated and included in this or the next report. A pre inspection questionnaire was sent out several weeks before the inspection and was returned and the information provided contributed to the report. In addition to examination of care records, accident records, medication records and staff records were also examined in detail. A tour of the building was also undertaken. What the service does well: What has improved since the last inspection? Acefield Care Home DS0000016357.V317767.R01.S.doc Version 5.2 Page 6 The manager has worked very hard to complete a new care planning system for each resident complete with risk assessments. These are ‘user friendly’, easy to follow and reflect the current needs of the service users. Regular audits of the home by ‘walkabouts’ carried out by the manager and provider, have developed a rolling programme of redecoration and maintenance which is gradually improving the appearance of the home. What they could do better: 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. Acefield Care Home DS0000016357.V317767.R01.S.doc Version 5.2 Page 7 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 Acefield Care Home DS0000016357.V317767.R01.S.doc Version 5.2 Page 8 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 & 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Satisfactory systems are in place to ensure prospective service users needs are assessed and assurance is given to them that the home can meet their needs. This home does not provide intermediate care. EVIDENCE: A copy of the Service Users Guide was seen in each of the rooms visited. Amendments have been made and now contain accurate information with one exception where it is stated that the manager is currently undertaking NVQ 4. She is not due to commence until April 2007, after which time this statement can be included. All of the residents who have been admitted since the last inspection were seen and spoken with to include one gentleman admitted on the first day of the site visit. He and his wife were spoken with on the second day. Acefield Care Home DS0000016357.V317767.R01.S.doc Version 5.2 Page 9 He is obviously not yet used to living in the home, but his wife is hoping that he will settle in soon. She visited the home prior to his admission, chose the room and bought some personal items from home to include his armchair. The others spoken with had been at the home a longer time and had all settled although as two said they had adapted to living in care but they would still prefer to be in their own home if that was possible. The manager visits each service user prior to admission and completes a preadmission assessment form, to ensure that their needs can be met by the home. These forms were seen completed when the care files were examined. Acefield Care Home DS0000016357.V317767.R01.S.doc Version 5.2 Page 10 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. The home has a care planning system in place to include an assessment of service users needs. This ensures care plans are providing staff with adequate information to meet service users needs. Service users health care needs are mostly met. Service users are still not fully 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. Acefield Care Home DS0000016357.V317767.R01.S.doc Version 5.2 Page 11 EVIDENCE: The manager has worked very hard since the last inspection to review and renew all the care plans, making them much more ‘user friendly’. Six care files were examined in detail during the site visit to include all of the service users admitted since the last inspection. All had an assessment completed; these consist mainly of tick boxes but are based on the activities of daily living and give a clear picture of each resident. From these, problems are identified and appropriate care is planned. All of those seen reflected the current needs of the service users with one exception where some had been admitted with mental health needs such as depression. It was discussed that where this has been identified as a problem a care plan should be devised to ensure that the care is monitored regularly and that mental as well as physical needs are being met. An example care plan for this need was devised by the second day of the site visit and approved of. When nutritional needs have been identified residents should then be weighed regularly, but the home does not have a ‘sit on scales’. This needs to be addressed to ensure that this problem is monitored and addressed fully. It was noted that fluid balance charts are in place where staff have to ensure that adequate fluids are being given. However, what was absent was a record to indicate that a resident on permanent bed rest was being turned on a regular basis. This is necessary, even when nursed on a pressure relieving bed, to ensure that their position is changed frequently to reduce the risk of pressure sores. Risk assessment forms are also completed for each resident, identifying when someone is at risk of falling, or who wanders for example, and appropriate action indicated. Moving and handling risk assessments are also completed. Part of the risk assessment form records where bed rails have been identified as appropriate to use in certain cases and have been signed by the service user/their relative. However it was noted that where these are in use protective bumper pads have not been provided and could put the service user at risk of head or limb entrapment. This must be addressed. There was some evidence that some care plans (4) have been completed/discussed with service users/their relatives, but it was emphasised that this should occur with each service user/their representative wherever possible. Acefield Care Home DS0000016357.V317767.R01.S.doc Version 5.2 Page 12 A record of professional visits is also kept which confirms the home’s involvement with outside agencies such as the doctor, district nurse, continence advisor, community psychiatric nurse, optician and dentist. Care staff keep daily records reporting on events from each shift. These remain quite brief but have improved and are currently being reviewed by the manager and deputy. There were still one or two inappropriate entries seen. The manager is aware of these and will address this with the relevant staff who are to be reminded that these are legal documents. Carers observed during the site visit behaved respectfully to service users and both service users and their relatives stated they were satisfied with the care provided. However, there were several comments from last years survey carried out by the home about lack of privacy and it was noted on this occasion that when the wife of the newly admitted service user arrived, he was taken to his room with his consent, which indicates that this situation has improved. The location of the staff handover was also discussed. In the current location it is possible that staff maybe overheard by service users and visitors to the home. A more suitable/quiet area needs to be found for this purpose. Although there has been a marked improvement over time with the medication procedures in the home, there were still several areas of recording noted which could put the service users at serious risk. The dispensing pharmacist audits three-monthly and liaises with the home regularly, In several instances when carrying out a random audit trail it was found that a tablet was still in the blister pack for certain days but had been signed for and on other occasions was missing but had not been signed for. This could indicate that either medication is not being given as regularly as it should be or because a tablet has not been signed for there is a danger that it could be administered twice. There has also been a report from a relative that tablets had been found in the service users handbag, which indicated that staff had not actually witnessed the tablets being taken. The manager and deputy have started an audit of medication records and must follow-up indications of error by ensuring that the member of staff is offered further training/supervised practice. The pharmacy inspector from the Commission will return in the New Year to ensure that their audits have been successful. Records of receipt and disposal were seen. Storage is generally satisfactory although there is still a tendency to overstock with a few items such as lactulose. In most instances medication is being dated on opening, although some liquid medicines were discarded as there was no date of opening on them. It was also noted that not all staff record variable doses. Acefield Care Home DS0000016357.V317767.R01.S.doc Version 5.2 Page 13 The home does have a medication policy, a copy was provided to the Commission and all staff who administer medications have reportedly received accredited training, but there is still little written evidence to support this, and it is apparent that not all staff are so careful in their administration methods as others. This must be addressed before a serious error occurs. Acefield Care Home DS0000016357.V317767.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 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Activities provided in the home aim to cater to individual needs of the residents providing them with meaningful ways of spending their time. Residents were able to choose their daily routine. Service users maintain contact with family, friends, representatives and the local community as they wish and are helped to exercise choice and control over their lives. The meals in this home are good offering variety, and catering for special dietary needs. EVIDENCE: The previous activities co-ordinator has recently left but a new one has been in post for a month and appears to be settling in well. She was spoken with during the site visit about her plans and service users spoken with appeared satisfied with the levels of activity and social events that take place. Acefield Care Home DS0000016357.V317767.R01.S.doc Version 5.2 Page 15 A weekly programme is planned and displayed around the home and residents are then given the choice as to whether they wish to attend or not. There are a number of residents who prefer one to one, rather than joining in with group activities. On the first morning of the inspection a small group went with dial a ride to a city library for coffee and to choose their books. They returned for lunch and said they had enjoyed the trip. A mobile library also calls at the home. In the afternoon a large group were enjoying a game of bingo, although one said ‘I never win’. On the second morning a communion service was taking place and the activities organiser was taking the opportunity to go round and chat with residents. She is at present trying to establish what everyone likes to do. One popular event which one resident related was cooking. Residents had made Cornish pasties during the summer and cakes for Halloween. Photos of social events are displayed throughout the home and a large poster depicting a poppy for Remembrance Sunday was also on display and several said they had enjoyed the service. Other events advertised for the week, included crafts, a memory book, a film show cards and dominoes and a coffee morning at St Paul’s Church. One resident also said that the church was having a bazaar on Saturday, which a few of them hoped to attend. One or two residents are still able to go out independently to town, shops, the church and local clubs. Others go out regularly with their relatives. Visitors are always made to feel welcome and there were only two visitors seen on this occasion. All the residents who were spoken with felt they were offered choice in how and where they spent their days. There was however one negative comments in the surveys collected last year by the home. It stated ‘ Not enough to do. More activities required instead of sitting around. General staff do not talk to residents very much’. It was following this survey that activities co-ordinators were employed. Positive comments include the following; ‘since my mother came into the care of Acefield we have been totally satisfied with her level of care. All the staff are extremely kind and patient and we have no concerns whatsoever. We would have no hesitation in recommending Acefield to any potential resident and their family’. Again, both residents and the relatives spoken with confirmed that everyone was happy with the food provided. Just one of the surveys from the home last year stated that ‘the food was not varied and offered no choice’. Acefield Care Home DS0000016357.V317767.R01.S.doc Version 5.2 Page 16 The menu does not offer a choice at lunchtime, but resident likes and dislikes are well known and alternatives are always available. A choice of breakfast and tea/supper is provided. The cook keeps a record of meals provided daily but was asked that this be kept in more detail, for example to state which vegetables and sweet are provided. It was also suggested again that the daily menu is displayed for residents and visitors to see. Some residents had already enquired and knew what the lunch was. Others said they never knew what to expect, ‘it was a surprise’ but was always good food/home cooking. Meals seen during the visit smelt and looked appetising. Daily records do briefly indicate when breakfast, lunch and supper are taken and sometimes give details of food provided. The home has two cooks; one was off-sick. One of the care staff was being allocated to catering duties the following week when the cook was on leave. Neither the cook nor any other staff have received food hygiene training recently and this must be arranged particularly for the cook and any care staff who deputise in her absence. All food safety checks are completed to include fridge and freezer temperatures, food probing and food labelling and dating. Soft diets are generally pureed separately. Residents with diabetes do not have a specific diet but all desserts are cooked with an artificial sweetener, so everyone can have the same choices. There are no there special diets to cater for at present. Acefield Care Home DS0000016357.V317767.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a complaints procedure in place and residents feel confident that concerns are listened to and acted upon. The home does not yet have adequate arrangements in place to ensure service users are not at risk of harm or abuse. EVIDENCE: The home has a complaints procedure implemented in 2003 and included in the service users guide. This was provided in each service users room. The home stated that they had not received any complaints since the last inspection and neither has the Commission received any formal complaints although some anonymous concerns were looked into as part of the inspection and were partly substantiated ( see standard 9). The home has its own policy on abuse and adults at risk file to include the ‘Alerters’ Guide’ provided by the Commission at the last inspection. Acefield Care Home DS0000016357.V317767.R01.S.doc Version 5.2 Page 18 Staff reportedly received training on adult protection from the Adults at Risk team last year but there is no recorded evidence on this. Further training has been booked with the Adult the Protection Unit to take place in February 2007. There is also a section on abuse included in the induction programme, but no written evidence seen to confirm that new staff had been instructed on this. All new staff should receive this as part of the mandatory training and other staff receive regular updates. Acefield Care Home DS0000016357.V317767.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The standard of décor and maintenance within this home is improving but the standard of cleanliness needs to be more robust to ensure that service users have a clean and hygienic home to live in. EVIDENCE: A tour of the building took place during the site visit with the manager. She and the provider now make regular tours of the home to compile a maintenance list, which is passed to the maintenance man for action. Acefield Care Home DS0000016357.V317767.R01.S.doc Version 5.2 Page 20 A copy of the October list was provided for the inspection and a number of the tasks on this had been completed. The exception to these was redecoration of some rooms. A contract decorator has been employed and is currently redecorating the hallways and staircases and the result is very good. It is hoped that his contract will be extended from the end of November to then continue a rolling programme of redecoration of the bedrooms, some of which have been identified as highest priority. Work has commenced in the toilet at the front of the house. A new floor and toilet suite has been fitted and it is now waiting for floor cover and redecoration in order to complete it. It is planned that the main front door will then be used to receive visitors once a new key- pad has been fitted. New air conditioning units were purchased after the last inspection and positioned in the conservatory and were reportedly very efficient during the hot spell in July. Furnishings in the communal areas are much improved and with the exception of two worn individual tables (which the manager said should have been removed) all other furniture appeared satisfactory. The home currently has two cleaners on-duty, the third being on long-term sick leave. Whilst appreciating that with the decorator in (although he provided dust sheets on the carpets) and building work ongoing in the front porch/toilet area, the dark carpets throughout the communal areas were dirty throughout the two days visit. Carpets in most of the bedrooms also appeared dirty with a number badly stained and two rooms were very odorous with the odour now infiltrating along the corridor. Another room had the protective mattress cover pulled back revealing a wet/stained mattress which was reportedly being replaced. This raised a question about the quality of all the mattresses in use and the manager was urged to put a mattress check and replacement programme into place. It was also noted that the base of one of the baths in the extension was very dirty and needed to be thoroughly cleaned. The home does need a more vigorous carpet cleaning programme in place and possibly a third temporary cleaner appointed in order to ensure that the home is kept clean and odour free. A comment made by one of the staff surveys was that ‘they would like to see the carpets changed to a lighter colour’. Acefield Care Home DS0000016357.V317767.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users needs are met by the numbers and skill mix of staff and are in safe hands at all times. Some training opportunities have been provided for staff to improve their skills but further training and a record to confirm this should be in place to ensure that staff are trained and competent to do their jobs. Improved recruitment procedures are in place to support and protect the service users. EVIDENCE: The manager, deputy manager and three care assistants were on-duty on commencement of the inspection. A fourth carer arrived at midday, called in Acefield Care Home DS0000016357.V317767.R01.S.doc Version 5.2 Page 22 early for her late shift (presumably because of the manager and deputy being occupied with the inspection). Four care staff and the manager were on-duty during the afternoon. There appeared to be adequate staff on-duty to meet the needs of the service users, who confirmed that they were well cared for by the staff. In addition to care staff, the activities co-ordinator, two cleaners, a cook and the maintenance man were all on-duty. On the second day of the visit three staff were interviewed; one had been at the home almost three months, the others had been at the home for some time and were about to commence NVQ training. The new member of staff brought in her induction programme, which she is working through. She is very happy in this post, feels well supported by the manager, deputy and all the staff and already has a good knowledge of all the residents and how to meet their needs. She has read through some of the care plans and plans to continue this. She expects a probationary interview at the end of three months. She confirmed that she has received fire and moving and handling training. The others interviewed had been at the home one year and seven to eight years respectively. Both were experienced carers although one seemed less confident than the other. One confirmed that she had received appraisals and supervision with the manager; the other said she had but described this as being informal. Both enjoyed working at the home and appeared to have a good knowledge of the residents and how to meet their needs. Both confirmed recent training they had undertaken and were due to take. All said how supportive the manager was. Other staff spoken with were the two cleaners, the activities co-ordinator and the cook. Three files were seen of all the new staff who have commenced since the last inspection. All of these contained an application form with full career history, confirmation of mental and physical fitness, two written references, a POVA first check and CRB disclosure and a photograph and other identification documents. There was no induction record for the activities co-ordinator or for the cleaner who said she had been shown what to do by one of the care staff. One had a start date missing and two had no interview record, but records generally were much improved. One, in addition to a recent CRB, had a photocopy of a CRB disclosure from a previous employer, which must be shredded. The carer confirmed that she had received a job description, and offer letters and terms and conditions were seen. Seven staff have now been enrolled to commence NVQ 2 training with Sunrise Training Limited part of Learning Direct. They have all attended their preliminary interviews and been given some paperwork. A phone call to the Acefield Care Home DS0000016357.V317767.R01.S.doc Version 5.2 Page 23 Company during the inspection revealed that their assessor/coordinator will be visiting them with the remains of their paperwork within the next week. Fourteen staff have recently attended fire training as confirmed by certificates seen. The home has their own moving and handling and first-aid trainers who both have certificates to 2008. Moving and handling, health and safety, first aid and health and safety training is due to be completed by January 2007. Unfortunately there are few records to support past training that has been undertaken by the staff in the home. This includes modular training on dementia, infection control and medication training. It is also unclear as to how frequently mandatory health and safety training is being undertaken by staff. The provision of a training matrix which will clearly demonstrate all the mandatory and other training planned and will clearly identify individual training needs, would be beneficial in developing a successful training programme for the home. Acefield Care Home DS0000016357.V317767.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): 31,33,35,36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The leadership, guidance and direction to staff has improved but a more structured programme of training and supervision still needs to be in place. The systems for service user consultation are improving but must be maintained. There are processes in place to safeguard the financial interests of service users. There continues to be some practices that do not promote and safeguard the health, safety and welfare of the people using the service. Acefield Care Home DS0000016357.V317767.R01.S.doc Version 5.2 Page 25 EVIDENCE: With the return of the deputy manager from long-term sick leave, the manager now has more support to fulfil managerial duties. This is evident with the complete review of the care planning system and the commencement of a supervision programme. She is also now able to undertake the registered manager’s award and has reported that she is due to start this in April 2007. Supervision records were seen during the site visit and staff spoken with confirmed that they had received supervision. This programme needs to be expanded to ensure that all care staff receive formal supervision at least 6 times a year and includes an annual appraisal. Formal staff meetings are only held when there is a specific topic on the agenda such as pay rises, but staff meet at each shift change for a handover period each day and all spoken with were well informed about the conditions of the service users. All said they felt well supported and made particular reference to the support given by the manager who in turn praised the loyalty and support of her staff especially for the period when she was working without the help of a deputy manager. Staff surveys were handed out during the inspection and of the few returned to date they all confirmed that there was nothing they could think of which would improve the home, one thing they felt the home did really well was to provide a ‘lot of love and 100 care to the residents’ and ‘hope that they and their relatives are satisfied with the service provided’. The manager reported that the home does not act as an appointee for any residents’ pension and does not deal with any financial transactions for the residents. This is the sole responsibility of the residents and their families. It was reported that there is no longer any money held in safe keeping for any resident. The home carried out a quality assurance satisfaction survey in May 2005 sending surveys to each resident/their families; seventeen were completed. The results of these have still not been collated or an improvement plan developed to indicate that the views given have been acknowledged and/or acted upon. This must now be put in action as a further survey is due to be sent out. There are also plans to send surveys to visiting professionals to the home. Daily records and medication records are now to be audited weekly and a regular maintenance/environmental audit is carried out (see standard 19 above). Accident records are checked and an accident audit is now completed and was seen. Acefield Care Home DS0000016357.V317767.R01.S.doc Version 5.2 Page 26 Recent accident records were seen and where any patterns emerge from the audit, an action plan is developed where appropriate. It was noted that in the daily records it had mentioned an accident several days ago that did not appear to have an accident form completed. Further investigation revealed a form had been completed but with the wrong name. Staff must ensure that accurate records are kept, as inaccuracies in names would have serious consequences if for example a Coroner’s investigation was necessary. There were fewer health and safety risks identified on this occasion. Hopefully, this has improved since the manager and provider carry out their own regular inspections of the premises. One noted was lack of bumper protection pads when bedrails are in use ( see standard 8 above). Other areas that the home has not fully complied with are to ensure that all staff receive regular mandatory health and safety updates, with written evidence to support this. These include moving and handling, first aid, and food hygiene training. A recent letter copied to the Commission from the Fire Safety Officer revealed that there were still a number of unaddressed requirements from their last inspection carried out in December 2005. Some of the contraventions had been rectified, but others had not and the period of compliance had been extended to 1st November 2006. The manager reported in the improvement plan that all these had now been addressed. They had employed a new contractor to check and address all of their fire safety issues and he had done this. The inspector has since contacted the Fire Safety Officer and is currently waiting for confirmation that he is satisfied with the work completed by the contractor. Staff training had recently been carried out (see standard 30 above). Records were not seen of fire safety checks such as fire alarm and emergency lighting checks, on this occasion but are reportedly being completed by the maintenance man whose records were checked by the contractor. Failure to comply with fire safety requirements endangers the lives of the service users and staff and must be rectified. Acefield Care Home DS0000016357.V317767.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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 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 3 X X X X X X 1 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 2 Acefield Care Home DS0000016357.V317767.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement Ensure that where possible all care plans are completed with the service user/their relatives and reviewed with them. Timescale for action 31/01/07 2. OP9 13 3. OP18 13(6) The registered person shall make 31/01/07 effective arrangements for the recording, handling, safe keeping, safe administration and disposal of medicines received into the care home. This is in respect of keeping complete and accurate records of medicines administered according to the directions of the doctor, recording the actual dose given and completing and recording monthly/weekly audits to demonstrate that residents are receiving their medicines correctly. This requirement is outstanding from the last inspection and the timescale of 31/07/06 was not met. The registered person must 28/02/07 make arrangements, by training staff or other measures, to prevent service users being DS0000016357.V317767.R01.S.doc Version 5.2 Page 29 Acefield Care Home 4. OP26 16 harmed or suffering abuse or being placed at risk of harm or abuse. The registered manager must make suitable arrangements for maintaining satisfactory standards of hygiene in the home. This requirement is outstanding from the last inspection and the timescale of 31/07/06 was not met. Ensure that staff receive training and regular assessment to ensure their competence to administer medications. Ensure that persons employed by the registered person receive training appropriate to the work they are to perform and suitable assistance including time off, for the purpose of obtaining further qualifications appropriate. This is in respect of records to confirm that staff have undertaken specific training on dementia, medication and infection control. It is also unclear as to how frequently mandatory health and safety training is undertaken by staff. This requirement has been repeated from the last four inspections and the timescale of 30/9/06 was not met in full. 31/01/07 5 OP9 18 31/01/07 6 OP30 18 31/01/07 7 OP31 10 The registered manager shall undertake such training as is appropriate to ensure that she has the experience and skills necessary for managing the care home. This requirement is outstanding from the last DS0000016357.V317767.R01.S.doc 31/01/07 Acefield Care Home Version 5.2 Page 30 inspection and the timescale of 30/09/06 was not met. 8 OP33 24 The registered person should maintain a system for reviewing at appropriate intervals and improving the quality of care in the home and should supply the Commission with a report and make a copy available to service users. The registered person shall ensure that people working at the home are appropriately supervised. The registered person shall ensure that unnecessary risks to the health and safety of service users are identified and so far as possible eliminated. This is in respect of the ability to weigh residents, protection against limb entrapment by bumper pads, infection control risk of using soled mattresses and prevention of pressure sores by use of turn charts. The registered person must after consultation with the fire authority take adequate precautions against the risk of fire. 28/02/07 9 OP36 18(2) 28/02/07 10 OP38 13 31/01/07 11. OP38 23(4) 31/01/07 Acefield Care Home DS0000016357.V317767.R01.S.doc Version 5.2 Page 31 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 OP1 Good Practice Recommendations Make necessary amendments to service users guide to reflect changes in the home. A minimum ratio of 50 trained members of care staff (NVQ 2 or equivalent) is achieved by 2005. The manager should have an NVQ 4 in management and care or equivalent. Sit on scales should be provided in order to carry out nutritional screening which should be undertaken on admission and subsequently on a periodic basis; a record maintained of nutrition including weight gain and loss and appropriate action taken. 2. OP28 3. 4. OP31 OP8 Acefield Care Home DS0000016357.V317767.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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 Acefield Care Home DS0000016357.V317767.R01.S.doc Version 5.2 Page 33 - 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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