Inspection on 19/06/06 for Bramble House

This inspection was carried out on 19th June 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 13/11/06

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 Unannounced Inspection 19th June 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Acefield Care Home DS0000016357.V298872.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.V298872.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.V298872.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25th October 2005 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 £325 for low dependency and £400.05 for high dependency. Chiropody, hairdressing and newspapers are charged for extra. Acefield Care Home DS0000016357.V298872.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 commenced on one day in May 2006, with the site visit that took place over 8 hours and was carried out by two inspectors. One inspector returned later that week to feed back to the provider. During this time the inspectors spoke to a number of residents, some relatives, staff working in the home and the manager of the home. Four resident’s files were looked at in detail to include their medication and accident records. Surveys were either completed during interviews with residents or their relatives, or were handed out to relatives/residents during and following the inspection and these results were later collated. What the service does well: What has improved since the last inspection? Recruitment has improved but there are still areas such as career history and references that are not fully explored. Acefield Care Home DS0000016357.V298872.R01.S.doc Version 5.2 Page 6 The medication system has shown some improvement in the last year, helped especially by using blister packs and typewritten medication administration records. However, most of the requirements from the last inspection have not been met in full, therefore there is little improvement from the last inspection. 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. Acefield Care Home DS0000016357.V298872.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.V298872.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1&3 Quality in this outcome area is judged to be good other than the longstanding requirement regarding up to date information in the Service users Guide. This judgement has been made using available evidence including a visit to this service. Service users are well informed about the home prior to admission although some of the information available in the home needs to be updated for accuracy which is an outstanding requirement from the last inspection. A full pre-admission assessment is completed to ensure that the needs of each resident can be fully met. EVIDENCE: The home has a Statement of Purpose and Service Users guide, a copy of which was seen in each service users room. Parts of this have been reviewed in 2004 relating to the homes’ smoking policy and activities, but there remain several inaccuracies related to staff training and qualifications and still refers to a smoking room which is currently not in Acefield Care Home DS0000016357.V298872.R01.S.doc Version 5.2 Page 9 use. A yearly review must be carried out to ensure service users and their families receive accurate information about the home. Four relatives were spoken with and all confirmed that they are very happy with the home, care and food, have no concerns, are kept well informed and feel that there is appropriate stimulation in the home. Two of these relatives visit almost every day so have a good picture of the home. Two took surveys away to complete. The home has admitted a number of new residents since the last inspection but three of these had gone on a church outing to Weston with staff from the home. One other who has been on extended respite care was seen both prior and on return from a hospital appointment. He was very happy with the home, said the food is really good and confirmed that he is given choice in what he does whilst his independence is maintained. Surveys were left for those residents who had gone out for the day and were returned at the second visit. All the comments made were very positive. Records of four newly admitted residents were seen and all had assessments completed. Acefield Care Home DS0000016357.V298872.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 Quality in this outcome area is judged to be adequate. This judgement has been made using available evidence including a visit to this service. Not all of the service user’s health, personal and social care needs are set out in the individual plan of care. Service users health care needs are fully met. Service users are still not totally 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 EVIDENCE: Four care files were examined in detail for the purpose of this inspection and included medication and accident records. All were found to have assessments completed on two different forms, one of which is now being discontinued and a new form introduced. There was just one form that was not signed. A sample pre-admission assessment form was seen but none were seen completed as the manager reported that all recent Acefield Care Home DS0000016357.V298872.R01.S.doc Version 5.2 Page 11 admissions had either been emergency admissions or admitted following respite care. Generally, as problems were identified, care plans were completed and these were then reviewed monthly but none were completed with residents or their families. It was also noted that in several instances there was a social services care plan but no care plans completed by the home although it was obvious in these cases that care plans for mobility in one case, and nutrition in another were required. In one instance it was identified that someone needed to be closely monitored for nutritional intake but no weight had been recorded (the manager said they did not have a scales in the home). There was therefore little indication that this person was eating an adequate diet and whether they were gaining or loosing weight. Each resident should be weighed on admission and after as necessary and scales must be made available for this. Other omissions such as type and size of pads in use were also evident and must be addressed. A moving and handling risk assessment is completed and reviewed monthly but no other risk assessment forms were seen and it was felt in one case that these should be in evidence for the use of bed rails and a body strap holding a resident in position in a special chair. The home has three residents who have diabetes controlled by diet and tablets. Records mentioned blood glucose monitoring but did not record the results. It was reported this was recorded elsewhere but advised to keep it in the care files. These records were asked for at the second visit but could not be found. No residents have catheters but one has a sacral pressure sore, which is being treated by the district nurse. A pressure relieving mattress and cushion are in place. Each care file has a form to record doctor and other professional visits but this is not used consistently. Care staff complete brief daily records but do not always record all the relevant changes and there were a lot of gaps left in recording. As these are legal documents, each page must be completed or a line drawn through to avoid retrospective records. Accidents were recorded in the daily records and cross- referenced with accident forms that had been completed. There was one incident found where an accident record was missing from the care file. Acefield Care Home DS0000016357.V298872.R01.S.doc Version 5.2 Page 12 The medication system has shown some improvement in the last year, helped especially by using blister packs and typewritten medication administration records. A new medication policy is in place and a copy provided. Storage has much improved with individual medications clearly accessible and most records are fairly well maintained. A record of receipt and disposal is kept and was seen. Each medication chart is fronted with a photograph of the resident and any specific instructions such as preferred time of day. However, where there are changes of medications half way through the month, staff are handwriting and these recordings are not always accurate. One tablet was recorded to be given 3 times a day on the chart and 4 times a day on the box; another said to give half a tablet but a whole tablet was given each night; one tablet had not been given since 7th June because it was not available and there were several other medicines recorded, mainly analgesia, that could not be found in the trolley or medicine cupboard. There is also some discrepancy in the use of analgesia; some is recorded to give up to four times a day as necessary where others state give four times a day but all are given as necessary rather than as regular doses. This should be clarified with the dispensing pharmacy. The manager was informed of all the discrepancies and these must be followed up as inaccuracies put the service users at risk of overdose or not receiving enough medication. A random weekly audit is completed to count numbers of tablets, but this should be expanded to check accuracy of records and two staff should check for accuracy, and countersign each handwritten entry made. Staff have all received some training on medications but those spoken with do not feel it is enough and would like further basic information on common medicines in use and regular updates on administration. Service users observed in the lounge were all addressed politely, were told what was about to happen, where they were going and what for etc. and spoken to politely, in a friendly manner and appropriately. Dignity, privacy and respect was demonstrated by all carers observed. One example was a carer showing one resident her new room on the ground floor. This was done in a very gentle and caring manner. Residents were spoken ‘with’ and not ‘at’ by the carers and relatives were also being kept informed of all that was going on. Acefield Care Home DS0000016357.V298872.R01.S.doc Version 5.2 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is judged to be good. This judgement has been made using available evidence including a visit to this service. Residents continue to experience a stimulating and varied life at the home with visitors and community links encouraged, various informal activities being made available and appetising food being provided. EVIDENCE: A notice board in the main hall indicates the day and date, and photographs of social events are displayed along the hall and in the conservatory area. The weekly programme of events is also on display and included dominoes, word games, exercises to movements, art classes, coffee mornings at the local church and bingo. The hairdresser visits each week and communion is held monthly. Manicures are also popular as is sitting in the garden when the weather is warm. On the day of inspection five service users and staff to include one cook and the activities co-ordinator joined an outing to Weston super Mare organised by the local church, which several attend regularly. Acefield Care Home DS0000016357.V298872.R01.S.doc Version 5.2 Page 14 The previous weekend the home had held its annual fete and raised quite a lot of money for the residents’ social fund. Daily records seen also mentioned visits to the church, eating an Indian takeaway, decorating Easter eggs, going on a picnic in the park and shopping and making banners for the World Cup. The conservatory was also decorated with St George flags. One resident stated that ‘she joins in with everything, she really enjoys it’; whilst another said she doesn’t join in activities as ‘I just enjoy reading my books, reading the paper and doing the crossword’; one was upset that he not able to go out often now and has to be accompanied as he is unsteady; one relative spoken with feels satisfied that his mother who visits daily for day care is stimulated during her visit and that the activities are appropriate and good. Visitors are always made to feel welcome and there were a number of people visiting throughout the day. One felt that visitors received good support as well as the residents. All who were spoken with felt they were offered choice in how and where they spent their days. Again, both residents and the relatives spoken with and surveys completed confirmed that everyone was happy with the food provided. 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-duty, and they work out the menu between them and through discussions with residents as to their likes, dislikes and preferences etc., which are well known. The cooks always see new residents. The menu is displayed in the kitchen and it was suggested it should also be displayed for the residents. There are never any restrictions put on menu planning and ordering. Fresh vegetables are ordered locally and other food stores delivered weekly. All food safety checks are completed to include fridge and freezer temperatures, food probing and food labelling and dating. The cook said that residents are able to have anything they want anytime of the day. One resident helps out at a Charity shop and a late lunch is prepared fresh for her each Friday, on her return. If anyone doesn’t want the meal when it is served they are offered alternatives such as omelettes or a sandwich, but basically ‘whatever they fancy’. Soft diets are generally pureed separately although one has theirs mixed as a preference. One other on this occasion was also pureed together. 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.V298872.R01.S.doc Version 5.2 Page 15 One relative assists her husband with his meal each day when she is in, but staff assist him otherwise; the son of the lady who receives day care, and who is West Indian was asked if she had any special dietary needs, but she does not other than a soft diet. Lunch being served was fish cakes, mashed potatoes and peas and apple crumble and custard; tea was cheese and potato pie, cauliflower cheese, or sausages and a slice of cake and/or biscuits. Acefield Care Home DS0000016357.V298872.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is judged to be good. This judgement has been made using available evidence including a visit to this service. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users are protected from abuse. EVIDENCE: The home reported that they had received no complaints since the last inspection and the Commission has also not received any complaints. The home has a complaints procedure included in the Service Users Guide and this has been amended to now refer to the Commission for Social Care Inspection (CSCI). One relative spoken with stated that ‘he has no concerns about the care or the home and is always confident to discuss concerns with the manager and staff and knows whom to approach’. A second relative was also positive about the home, the care and the staff. One survey received stated that ‘if I were unhappy I would talk to the carers as they talk to you and buck you up when you feel low’; they also said they had no complaints but would tell the staff if they did. A second survey named the manager as the person to complain to and said something is always done if there is a problem and if you need anything the staff will sort it out or help. Acefield Care Home DS0000016357.V298872.R01.S.doc Version 5.2 Page 17 The home has its own policy on abuse and adults at risk file and was given the ‘Alerters’ Guide’ to add to this. Staff received training on adult protection from the Adults at Risk team last year but there is no recorded evidence on this. Staff spoken with confirmed they had received this and found it interesting. One received adult abuse training from her previous employers and stated that if she observed abusive practice or saw anything that bothered her she would talk in confidence to the manager or deputy. She had confidence in the manager who she said is a good manager. 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.V298872.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is judged to be poor. This judgement has been made using available evidence including a visit to this service. The standard of décor within this home was satisfactory but as there is still more room for improvement with maintenance, service users still do not live in a safe well-maintained environment. The standard of cleanliness and infection control also needs to be more robust to ensure that service users have a clean and hygienic home to live in. EVIDENCE: Most of the rooms in the home were visited. Most areas were clean and in satisfactory decorative order. It was reported that several rooms-18, 19 and 4 had been redecorated and refurbished since the last inspection. Acefield Care Home DS0000016357.V298872.R01.S.doc Version 5.2 Page 19 The manager reported that she either does a regular walk around the home with the maintenance man or the provider to check when any work needs to be completed and to look for any health and safety issues. There had been no hot water in the extension for four days; it had been reported and they were waiting for a part for the boiler. This was due to be fixed on the second visit to the home but no-one had arrived by 4 pm. Residents were able to use another bathroom or the shower room on the same floor but water was carried to their rooms if they required a wash. The conservatory was also being used for dining only through the hot weather as it was to hot for residents to sit all day. Air conditioning units or ceiling blinds are to be considered as a long-term plan. At the last inspection a number of small tables that had been purchased had been withdrawn and were waiting to be sent back as they had been considered unsafe. It was now reported that they had been made safe and were in use. A number of areas requiring general maintenance were noted as listed below: • • • • • Room 15: The radiator was very hot and the radiator cover was not fixed securely to the wall. Bathroom next to room 15 had no toilet roll holder A foam fire extinguisher was standing on the floor and should be secured to a wall and furniture and boxes were seen on two landings, which could obstruct fire exits and should be removed. Some wallpaper is missing and needs replacing on one staircase wall. Room 8 has a cracked wall that requires attention. The mattress is too small for the divan base and is unprotected presenting an infection control hazard. The resident in this room was moving to a ground floor room that day. Room 7 has a loose door handle which may fall off locking the resident in the room. Room 6 the bath mat needs replacing and tile grouting needs refreshing. Plans to remove the bath, which is impractical to use are being considered. Room 4 curtain rail has fallen off the central fitting and is hanging down; the bed table- top is worn exposing wood underneath, which is an infection control hazard as it cannot be cleaned properly. In the laundry there was no bin lid on the green bin. The bathroom on first floor of the main building had no restrictor on the window. • • • • • In addition to this there were several infection control issues noted, largely being the number of unmarked toiletries in communal bathrooms, suggesting that they may be communally used; these included razors, deodorant and flannels. Few communal bathrooms and toilets had single dispensing hand soap and those that did also had tablet soap, which should be removed. Acefield Care Home DS0000016357.V298872.R01.S.doc Version 5.2 Page 20 Work has begun on securing the garden to ensure that anyone who may have a tendency to wander can do so safely with no danger of walking out onto the main road. A gate is fixed at the side of the home and fencing is being constructed at the rear, to enable residents to look into the orchard area but not walk there as it has a very uneven surface. At the second visit the fencing had been completed. Acefield Care Home DS0000016357.V298872.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is judged to be poor. This judgement has been made using available evidence including a visit to this service. Staff are employed in sufficient numbers to meet the residents needs. Staff morale remains high with a low staff turnover that ensures consistency for the residents. The procedures for the recruitment of staff have improved but must be maintained to protect the people living in the home. A staff training programme has commenced but needs to be developed to include NVQ training. EVIDENCE: There were four care staff and the manager on duty on the day of inspection. In addition to this there was a cook, two cleaners and a maintenance man. Three of the care staff and the cook were spoken with. The care staff had worked at the home for 1year, 6 years and 16 years. The cook commenced in September 2005. The staff stated that there was no key worker system in the home but they had more time to spend with the residents now as they are less dependent and they felt the activities co-ordinator was very good and also did a lot with the residents. They all enjoyed their work. They confirmed that the home had regular meetings, which were minuted. Acefield Care Home DS0000016357.V298872.R01.S.doc Version 5.2 Page 22 The provider does not usually attend but is always approachable when he visits. A handover is also given at each shift change. The care staff write the daily records and feed-back any changes in condition to the manager or deputy. They all had access to the records and knew all about the residents and how to meet their needs. The newer member of staff said what a good supportive team there is and it is a happy place to work. She feels there is enough time to give to the residents and they are given choice. Residents spoken with confirmed that the staff were very caring and met their needs. Although it was reported that in general staff were reluctant to do NVQ training and no applications had been made to do so, the three care staff spoken with were all keen to start. This must be addressed, as the lack of this training has been an ongoing concern and a repeated requirement from the last three inspections. The home commenced a modular distance-learning programme for a number of topics to include medications last year. A monthly progress sheet was initially sent to CSCI for monitoring but this ceased several months ago and although the most recent record shows that a number of staff have completed some modules on medication, infection control and dementia, the staff spoken with have not had any feedback from the work they completed and have not progressed to the final knowledge paper which is sent off and a certificate awarded. This progress needs to be maintained by all the staff and audited for its effectiveness. One of the care staff has completed a moving and handling trainers course, last updated in June 2005 and due to be renewed in 3 years, and has taken on the responsibility of training and updating staff on moving and handling and supervising staff on these practices. She reported that she had updated the day staff but not the night staff as yet and there were no records to say this had been completed. There is also an absence of mandatory training records to confirm when fire, health and safety, food hygiene and first aid training was last completed for each member of staff, although some certificates were seen in a few staff files that had been selected. The manager has completed a trainer’s course for Practical First-Aid and is now able to instruct staff on these procedures. Sixteen staff received training and certificates in February 2005. The cook last completed food hygiene training 8 years ago. This must be updated. She is also keen to do the advanced certificate after which she would be able to train the staff in basic food hygiene which all care staff should do as they all have access to the kitchen and handle food. It was reported that the staff recently had additional medication training from two local dispensing services; one provided a certificate. Acefield Care Home DS0000016357.V298872.R01.S.doc Version 5.2 Page 23 Records of two newly appointed staff were seen. Both had completed application forms, health questionnaires and had provided two written references although one was from a relative. A further reference is required. A full career history was given but dates need to be in full rather than ‘2002’ as an example. There could be several months unexplained gaps between years. CRB and POVA First checks are also completed, but one had no photograph or identification documents on file. There were no interview records or induction records seen other than an example produced by the distance- learning programme that was not seen completed. Acefield Care Home DS0000016357.V298872.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36, 38 Quality in this outcome area is judged to be poor. This judgement has been made using available evidence including a visit to this service. The leadership, guidance and direction to staff has improved but there still does not appear to be a clear development plan in place for the home and areas such as training and supervision still need to be addressed. 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.V298872.R01.S.doc Version 5.2 Page 25 EVIDENCE: Until recently the manager has been working relatively unsupported as there was no deputy available despite the Commission meeting with the provider and manager and discussing this was necessary to ensure managerial duties were fulfilled. The deputy manager has now returned to work part-time and the manager confirmed that she will be commencing the registered manager’s award in September. Written confirmation of this placement is required. The manager 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 commenced a quality assurance programme last year and sent surveys to each resident/their families; the results of these have not yet been collated and an improvement plan developed to indicate that the views given have been acknowledged and/or acted upon. A further survey has been organised to commence shortly. Other survey possibilities were discussed including one to visiting professionals to the home. Other audits such as random medication checks are carried out and the results were seen, but it was suggested that medication records should also be audited as should daily records so that any shortfalls can be identified and drawn to the attention of the staff responsible to rectify. Accident records are checked but no general record to monitor patterns is kept, which would be beneficial. However, a problem was identified with one newly admitted resident who was falling quite frequently after admission and timing of night sedation was changed, after which the falls ceased. Staff confirmed they had received some supervision but new staff received it initially and then none since. The supervision records seen indicated that staff had been observed carrying out certain activities such as feeding a resident or giving moving and handling training but there was no record of formal one-to- one sessions when staff are able to express their training needs or where these have been identified. This is apparent from staff who want to do more training but the manager is unaware of this. Now that the deputy manager has returned to work it will be expected that supervision will continue aiming for all staff to complete 6 periods of supervision a year. Acefield Care Home DS0000016357.V298872.R01.S.doc Version 5.2 Page 26 There continues to be several potential health and safety risks identified during the tour of the building. These include carrying hot water into bedrooms, because the hot water system is not working, hot radiators and insecure guards, unrestricted windows and lack of fire and health and safety training and updates for staff (see standards 19 to 26 above, for details). A fire inspection was carried out in December, when a number of items were detailed for attention and a return made by the fire safety officer in April, finding very few of the contraventions had been rectified. A copy of the report was made available to the inspectors. The time to rectify these was extended to July 1st 2006 and the progress of this compliance was checked at this visit. One door closer had been replaced but it was reported that the other was on order. Formal staff training has been booked for August, the trainer apparently not being available before then but several staff spoken with, to include someone fairly recently appointed had not received fire training to date, whilst another said she had received fire training from the manager but there were no written records to confirm this. Records were seen of fire safety checks such as fire alarm and emergency lighting checks, but these were not being carried out as frequently as recommended. Some doors were noted wedged open and potential hazards and faulty installation of equipment as noted above were also noted. Failure to comply with fire safety requirements endangers the lives of the service users and staff and must be rectified. Acefield Care Home DS0000016357.V298872.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 2 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 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 3 1 X X X X X X 1 STAFFING Standard No Score 27 3 28 1 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 1 Acefield Care Home DS0000016357.V298872.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 OP1 Regulation 6 Requirement Ensure that the Statement of Purpose and Service Users guide are reviewed regularly and revised where necessary. This requirement has been repeated from the last inspection. Ensure that individual care plans reflect current needs of service users. This requirement has been repeated from the last inspection. Timescale for action 31/07/06 2. OP7 15 31/07/06 3. OP9 13 4. OP19 23 The registered person shall make 31/07/06 arrangements for the recording, handling, safe keeping, safe administration and disposal of medicines received into the care home. A rolling programme of 31/07/06 maintenance, redecoration and refurbishment must be implemented and maintained This requirement has been repeated from the last inspection Acefield Care Home DS0000016357.V298872.R01.S.doc Version 5.2 Page 29 5. OP26 16 The registered manager must make suitable arrangements for maintaining satisfactory standards of hygiene in the home. The registered person shall not employ a person to work at the care home unless the person is fit to work at the home and the registered person has obtained in respect of that person the information and documents specified in paragraphs 1 to 7 of Schedule 2. This requirement has been repeated from the last two inspections. 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 requirement has been repeated from the last three inspections. 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 has been repeated from the last inspection. The registered person shall ensure that unnecessary risks to the health and safety of service users are identified and so far as possible This requirement has been repeated from the last two inspections. 31/07/06 6. OP29 19 31/07/06 7. OP30 18 30/09/06 8. OP31 10 30/09/06 9. OP38 13 31/07/06 Acefield Care Home DS0000016357.V298872.R01.S.doc 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. 2. Refer to Standard OP1 OP8 Good Practice Recommendations Make necessary amendments to service users guide to reflect changes in the home. Nutritional screening 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. Handwritten or typewritten medication transcriptions should be checked and signed by two authorised staff trained in medication, that the charts are accurate before use. 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. 3. OP9 4. 5 OP28 OP31 Acefield Care Home DS0000016357.V298872.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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