Inspection on 11/04/07 for Brooklands 2

This inspection was carried out on 11th April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Brooklands 2 10/10/07

Brooklands 2 24/10/06

Brooklands 2 03/11/05

Brooklands 2 20/07/05

Brooklands 2 17/03/05

Brooklands 2 06/10/04

Similar services:

Flint House

Hillview Farm

St Vincents

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

The Cotswold Home

Fairways

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

CARE HOMES FOR OLDER PEOPLE Brooklands 2 11 Old Parr Road Banbury Oxon OX16 5HT Lead Inspector Christine Sidwell Unannounced Inspection 11th April 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000046642.V331026.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. DS0000046642.V331026.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Brooklands 2 Address 11 Old Parr Road Banbury Oxon OX16 5HT 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) 01295 262083 01295 278404 mail@brooklandsnh.co.uk Brooklands 2 Ltd Mrs Doolyn Lacey Care Home 36 Category(ies) of Old age, not falling within any other category registration, with number (36) of places DS0000046642.V331026.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Temporary increase in registration. Temporary increase in registration from 32 to 36 beds for a period of six months commencing 05 June 2006 to provide accommodation for residents who need an alternative location during the first phase of the expansion project at Brooklands 1. Any extension to this period must be discussed with the Commission. 24th October 2006 Date of last inspection Brief Description of the Service: Brooklands 2 is a three storey late Victorian town house situated in a residential road within easy access of Banbury town centre. The proprietors Mark and Madeleine Taylor also own Brooklands 1, another nursing home nearby, and during the current expansion of Brooklands 1 the Commission has agreed that some residents from Brooklands 1 can be temporarily accommodated at Brooklands 2. The accommodation at Brooklands 2 is spread over three floors served by a passenger lift. The home has temporarily adjusted the accommodation from 17 single rooms and 6 double rooms to 18 single rooms and 9 double rooms; two of the new double rooms were previously lounges. There is an assisted bathroom on each floor, and a small enclosed garden and patio area at the rear of the building. As a temporary measure to accommodate the residents transferred from Brooklands 1, three temporary rooms are in use as lounges and a dining room with covered ramped access from the main house. There is a registered nurse on duty at al times supported by a team of care staff. Fees range from £627.00 to £721.00 per week. There are additional charges for hairdressing, chiropody and personal items. Some additional charges may also be made for outings and to accompany people to hospital appointments. DS0000046642.V331026.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was conducted over the course of three days and included a six hour unannounced evening visit to the home. The key standards for older people’s services were covered. Information received about the home since the last inspection was taken into account in the planning of the visit. A Random Focused inspection was carried out 23rd January 2007 response to concerns about the care of residents. The findings of that inspection were included in the planning of this key inspection. Prior to the visit, a questionnaire was sent to the manager with questionnaires for distribution to service users, relatives and visiting professionals. Six residents, fourteen family members and seven healthcare professionals returned the questionnaires. Residents and families were also spoken to on the evening of the unannounced visit. Discussions took place with the proprietors, nursing and care staff. Care practice was observed and the care of four residents followed through in detail. A tour of the premises and examination of records was also undertaken. The homes approach to equality and diversity was considered throughout. What the service does well: What has improved since the last inspection? The Statement of Purpose and Service User’s Guide have been updated to reflect the current situation in the home and to give the contact details of outside agencies to assist residents and their families. The care plans have improved and now contain greater and more relevant detail as to the care residents should receive. The advice of the local Primary Care Trust ‘falls service’ has been taken and the number of resident falls has reduced. Medication management has improved. Risk assessments are now undertaken to identify potential risks that residents may have. The general practitioners who returned the comment cards expressed satisfaction with the care in general. DS0000046642.V331026.R01.S.doc Version 5.2 Page 6 A named nurse and key worker system is being implemented to be a key point of contact for residents and their families to ensure that residents needs are met and concerns are addressed promptly. What they could do better: The home must be careful to work within its registration categories if potential residents and their families can have confidence that the home will be able to meet their needs in a safe and knowledgeable way. Many residents whose primary need for care was physical also had cognitive decline, which made them especially vulnerable. Residents personal hygiene needs should be met at all times. Residents must have a drink within reach at all times and an accurate record of food and fluid intake must be kept where residents have nutritional difficulties. The number of falls must continue to monitored and staff deployment adjusted if necessary to prevent residents coming to harm. The home should ensure that residents have adequate clothing including stockings and socks to help residents maintain their dignity. Residents enjoyed their meals although they could be improved by making a choice available at lunchtime. Residents who have the supper in bed should be sat up in bed in order that they can eat better. There are complaints policies and procedures in place although not all families feel that their concerns are addressed. This should be addressed and residents and relatives concerns should be acted upon as far as is possible. There is a need to ensure that all staff have training in safeguarding vulnerable adults and that records are kept and that the home is fully aware of the local multiagency strategies for safeguarding vulnerable adults, to ensure that residents are fully protected. The infection control policies and procedures should be updated in line with guidance from the Department of Health to protect residents from potential acquired infection. The staffing levels and deployment of staff must be reviewed to ensure that vulnerable residents are not left unsupervised for long periods. The proprietors must monitor the staff training plan to ensure that it is delivered and that staff have the basic training required to care for residents safely. Whilst the recruitment procedures are satisfactory the proprietors must ensure that they can demonstrate that the required references and Criminal Records Bureau checks have been made prior to a new staff member starting work. The proprietors must continue to monitor closely the quality of care received by residents to ensure that their basic care needs are met in a safe and timely way. They must ensure that staff adhere to safe moving and handling practices and should consult with the Environmental Health Officer and check DS0000046642.V331026.R01.S.doc Version 5.2 Page 7 that the approach that they have adopted complies with the new guidance on ‘Safer Food Handling’. All staff who handle food should have food hygiene training. 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. DS0000046642.V331026.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000046642.V331026.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 3. The home does not offer intermediate care and therefore standard 6 is not applicable. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is information available to potential residents to help them decide whether the home can meet their needs. The home must be careful to work within its registration categories if potential residents and their families can have confidence that the home will be able to meet their needs in a safe and knowledgeable way. EVIDENCE: The home has information available to residents in the form of the Statement of Purpose, Service User’s Guide and descriptive brochures. The Statement of Purpose and Service User’s Guide have been updated since the last inspection and now contain more comprehensive and accurate information about the home. They also include information about the temporary changes that are necessary while parts of the home are being rebuilt to provide better accommodation and facilities for residents. Of the six people who returned the questionnaires, five said that they had received enough information about the home prior to moving to the home. DS0000046642.V331026.R01.S.doc Version 5.2 Page 10 The care of four residents was followed through in detail. Their files showed that they had been visited by the manager or the proprietor prior to moving to the home and that their care needs had been assessed. Two family members were also spoken to on the evening of the inspection and they confirmed that they and their family member had been visited. One said that the staff were meeting the needs of their family member, who had moved to the home on a temporary basis following discharge from hospital and who also had dementia, tactfully and with care. The home is currently not registered for the care of people with dementia although there are plans to do so in the sister home when the redevelopment is completed. The proprietor and registered manager must ensure that they are able to meet the needs of residents with dementia, even if that is not the primary reason for their moving to the home, if they are to be admitted to Brooklands 2 in the interim. The home does not offer intermediate care. DS0000046642.V331026.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ personal, healthcare and medication needs are mostly met. There remains a need to ensure that the progress made in describing resident’s care needs more accurately, reducing the number of falls and meeting residents’ nutritional needs is maintained and improved upon. EVIDENCE: The care of four residents was followed through in detail and the care plans of a number of other residents examined. At the last inspection a requirement had been made that the content of the care plans be improved in order to describe more accurately the care that residents need. It was evident from the care plans seen that considerable effort had been made to achieve this. The plans seen contained greater detail, had been updated regularly and the staff spoken to understood the needs of residents as identified in the plan. The care manager’s assessment and predicted plan of care and any discharge information from hospitals was also available. The plans had been updated on a regular basis. Of the five residents who returned the questionnaires all said that they always or usually received the care that they needed. The views of relatives were more diverse. Two said that their relative’s needs were always DS0000046642.V331026.R01.S.doc Version 5.2 Page 12 met, eight that they were usually met and four that they were sometimes met. The main concerns of the four families that were not happy with the care were that personal hygiene needs were not always met and that where a relative could not ask for care, this was not always anticipated. One family member said that his wife did not always have her hearing aid in although she did have it on the day of the unannounced visit. On observation the personal hygiene needs of residents had in general been met although some required fingernail hygiene. There was evidence in the care plans that resident’s risk of developing pressure damage and their moving and handling needs had been assessed. Two residents had pressure damage that had occurred in hospital or at home and was improving since moving to the home. They had the appropriate nutritional assessments and mattresses. One general practitioner said that he had confidence that this aspect of care was managed appropriately. The number of falls in the home had reduced since the last inspection and the home was now referring residents, who were prone to falling, to the local Primary Care Trust (PCT) falls service. However those who had fallen had been found on the floor and the home must ensure that vulnerable people are not left unsupervised. One lady on the top floor has a sensory mat alongside her bed, which is connected to the nurse call bell and alerts staff if she gets out of bed unaided at night. Nutritional screening is undertaken and resident’s weight is monitored monthly. Of the four residents whose care was followed in detail three had maintained their weight since moving to the home and one had lost three kilograms over eighteen months. The staff had reported this to the doctor and nutritional supplements had been prescribed. Her nutritional and fluid intake was being monitored although the document was poorly completed and did not give an accurate reflection of her actual consumption. The way in which nutritional intake is recorded for those residents at risk of nutritional deficiency should be reviewed as a matter of urgency. Not all residents had a drink within reach either in the lounge or in their bedrooms and this must also be addressed. Four general practitioners returned the questionnaires, three said that the home always sought their advice and acted upon it and one said that they usually did this. All said that the home always or usually met resident’s healthcare needs. There are medication policies in place. Storage facilities are cramped and the medication trolley is cramped and an additional cupboard has to be used. The stocks of medication seemed high on the day of the unannounced visit although the qualified nurse said that they had just received a month’s supply from the pharmacist. Records are kept of medication entering and leaving the home. The medication administration records were accurately completed. DS0000046642.V331026.R01.S.doc Version 5.2 Page 13 Controlled drugs were stored in a satisfactory manner and all entries to the controlled register were signed. There was evidence that the general practitioner reviews medication needs. Care is given in resident’s rooms and staff were observed to be speaking to residents courteously. The general practitioners confirmed that they could see their patients in private. Resident’s clothing was in general satisfactory although not all residents had stockings or socks and some had bare legs or were wearing bedsocks with slippers or shoes. The home should ensure that residents have adequate clothing including stockings and socks to help residents maintain their dignity. DS0000046642.V331026.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents have a choice as to how they spend their day and activities are available to bring interest and diversion to the day. Residents enjoyed their food although it could be improved by the provision of a choice at lunchtime and by ensuring that residents were in a position, which facilitated eating at suppertime. EVIDENCE: There is a full time activities coordinator who spends part of her time working with individuals on a one to one basis and part of her time on group activities. Outings are arranged and one resident said that she particularly enjoyed these. There is an additional charge for some outside activities. Residents who returned the comment cards said that there were always or usually activities available although two said that they did not like to join in and preferred to stay in their room. The relatives spoken to said that they were made welcome at any time although one who returned the questionnaire said that she felt that the home’ did not like evening visitors’. The residents who returned the questionnaire said that they usually or always enjoyed the food. There is a four-week rotating menu. The menus seen did not have choice of main meal. It was also stated that a bowl of salad and fresh fruit was to be available in the evening although this was not seen on the day of the unannounced visit. Eight residents were in bed at 5pm on the day DS0000046642.V331026.R01.S.doc Version 5.2 Page 15 of the unannounced visit. Several were trying to drink soup unaided whilst lying down. The home must ensure that residents are sat up in bed and assisted if they are to have supper in bed. DS0000046642.V331026.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are complaints policies and procedures in place although not all families feel that their concerns are addressed. There is a need to ensure that all staff have training in safeguarding vulnerable adults and that records are kept and that the home is fully aware of the local multi-agency strategies for safeguarding vulnerable adults, to ensure that residents are fully protected. EVIDENCE: There are complaints policies and procedures in place and a record is kept of complaints made. The residents who returned the questionnaires and those spoken to said that they knew who to speak to if they had any concerns. There was some evidence in the records that complaints are addressed constructively. However not all relatives have been satisfied with the response that they have received when they have complained. All families said that they knew how to make a complaint and that it was usually or always dealt with. Five families however said that they had had occasion to express concerns and that their concerns had not been addressed to their satisfaction. Three relatives were spoken to on the evening of the unannounced visit, one was happy with the service and care given, one had expressed a concern but it had been dealt with immediately and one felt that his complaints were never addressed and little happened in response to them. The proprietor said that he was introducing a named nurse and key worker scheme as one way to give residents and their families a key point of contact to ensure that their needs are met. DS0000046642.V331026.R01.S.doc Version 5.2 Page 17 The proprietors are aware of the lead person within Social Services to whom allegations of abuse should be referred and had general information regarding safeguarding issues. The manager stated that all staff had received safeguarding training although the training records did not confirm this. A number had covered this as part of adaptation courses or their National Vocational Qualifications. The proprietors had received one allegation of abuse, which they investigated, discussed with family and the resident’s General Practitioner who all felt that this was unsubstantiated and should not be referred on to Social Services. Whilst he allegation was investigated this was not in line with the local multi agency strategy. The proprietors should obtain an up to date copy of the Oxfordshire multi-agency strategy for safeguarding vulnerable adults and ensure that the action they take in response to any allegations are within these guidelines. DS0000046642.V331026.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although the environment is currently poor in many aspects, a refurbishment plan has been agreed and commenced, to provide better facilities for residents. The infection control policies and procedures should be improved to protect residents from potential acquired infection. EVIDENCE: The home is in an Edwardian building and there is a plan to refurbish it and to build an extension to better meet the needs of residents. It was reasonably clean and tidy on the afternoon and evening of the inspection although some slight odours were evident. There are temporary lounges, which have been erected to facilitate some room moves and allow for the redevelopment of the current home and another local home owned by the providers. These lounges are isolated from the main areas of the home and connected by a temporary walkway. DS0000046642.V331026.R01.S.doc Version 5.2 Page 19 Individual resident’s rooms vary in size. One lady spoken to said that she had lived at the home for two years and was very happy in her room. She had personalised it with her own belongings and many of her own pictures to remind her of her former garden. Because of the nature of the building some rooms are isolated and the proprietor has instituted a policy of encouraging lighter residents to occupy rooms on the third floor in order that evacuation mats could be used if there were to be a fire. One lady seen on the third floor had identified mental health needs and told the inspector that she was lonely although she did not like to sit in the lounge. She had a limited view from her window and the room was small although she had some of her own belongings around her. She was prone to getting out of bed at night and a sensory mat, connected to the nurse call bells, was placed alongside her bed to alert the night care staff if she got out of bed. The proprietors should consider whether this room is conducive to meeting the resident’s mental health needs as well as providing the supervision necessary to maintain her physical safety. The infection control policies and procedures are dated 2003. These should be updated to reflect the guidance on Infection Control in Care Homes issued by the Department of Health in 2006. Hand washing facilities are available although alcohol hand rub is not currently provided. Service users currently share hoist slings. They should have their own slings to assist in the prevention of acquired infection. The laundry is cramped and there is a plan to extend and refurbish it as part of the redevelopment of the home. DS0000046642.V331026.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The staff are kind and caring and in general have had the training that they need to provide care for residents. Their numbers and/or deployment must be reviewed to ensure that vulnerable residents are not left unsupervised. EVIDENCE: There is a staff record and the record confirmed the number of staff that were on duty on the day of the unannounced visit. On arrival at the home all staff were employed in taking out the suppers. There was no member of staff in the lounges. There were ten residents and one visitor in the lounge at the time. None of the residents seen would have been able to use the nurse call system. The visitor said that he had asked that someone be in the lounge at all times but, although this had improved, he came daily and often observed that residents were unsupervised. Since the last inspection the proprietors have introduced a policy where the lounges are checked on a half hourly basis. Given the isolation of the temporary lounges, the proprietors and registered manager must, as a matter of urgency, review the allocation and deployment of staff to ensure that vulnerable residents are not left unsupervised in the lounges at any time. The residents spoken to said that the carers were kind and gentle. The pre-inspection questionnaire showed that 52 of care staff hold the National Vocational Qualification in Care at level 2. The home meets the standard that 50 of care staff hold this qualification. DS0000046642.V331026.R01.S.doc Version 5.2 Page 21 Four recruitment files were examined. All staff had completed an application form although one did not show the person’s work history. There was no note as to why in the interview records. The staff member was spoken to at the unannounced visit and she had not worked in a formal capacity since the birth of her children. All contained 2 references although in the case of two members of staff one of these was from a friend. A Criminal Records Bureau disclosure had been sought for all staff although the original ‘POVA first’ email for two staff members had been destroyed when the CRB disclosure was received. The computerised records showed that it had been received but did state the date. It is recommended that a note be kept of the date that POVA first clearance is given in order that it can be demonstrated that staff members do not start work before this information is received. The staff spoken to had undertaken an induction programme and there is a training programme in place although the training matrix showed that not all staff had had the mandatory training with annual updates as required. The proprietors and registered manager should monitor the programme carefully to ensure that it is achieved. DS0000046642.V331026.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although there has been an improvement in the management and organisation of the home since the last inspection, a number of concerns do remain, which have the potential to affect resident’s well being. EVIDENCE: The pre-inspection questionnaire stated that the management of the home was shared between the proprietors and the registered manager. The proprietors state that they are primarily responsible for the administration of the home and the registered manager for the care. The proprietors stated that they visit the home on a daily basis. They stated that since the last inspection they have been working with the manager to improve the care and address the concerns raised and have also increased the number of audits that they are undertaking. The registered manager is a qualified nurse and has now registered to DS0000046642.V331026.R01.S.doc Version 5.2 Page 23 undertake the Registered Managers Award at National Vocational Qualifications Level 4. There is a quality assurance programme in place. Regular relative and staff meetings are held and the proprietors have been open about the adverse findings found at the last report and have taken steps to improve. The proprietors do not manage any monies on behalf of residents and all expenditure made on their behalf is invoiced. There are health and safety policies and procedures in place although regular health and safety meetings are not held with staff. Risk assessments are undertaken. The proprietor is encouraged to undertake a self-audit of the health and safety arrangements in the home in line with the guidance issued by the Health and Safety Executive on Health and Safety in Care Homes. Not all staff had had manual handling at the time of the inspection and the manager had arranged additional courses to address this. Some poor practice was observed, when transferring a resident from an armchair to a wheelchair. This must be addressed. The Environmental Health officer visited the home in December 2006. Two requirements were made about the facilities in the kitchen, which were addressed. A copy of the ‘Safer Food Handling’ Guidance was left although the home is still using its original record books, which they had adapted to meet the new guidance. It is recommended that the proprietors seek the advice of the Environmental Health officer as to whether their amended documents meet the guidance. The training matrix did not show that staff who handle food had received food hygiene training. It is recommended that this arranged. Training was being arranged for kitchen staff. The fire safety records were examined and found to be complete. Additional fire safety equipment has been purchased to aid evacuation on the third floor. Although there has been an improvement in the management and organisation of the home since the last inspection, a number of concerns do remain about the management of complaints, the deployment and supervision of staff and the training of staff in basic health and safety matters such as manual handling and food hygiene, which have the potential to affect resident’s well being. DS0000046642.V331026.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 2 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X 2 X 2 STAFFING Standard No Score 27 1 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 X X 2 DS0000046642.V331026.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard OP8 OP8 Regulation 12(1)a 12(1)a Requirement Residents’ personal hygiene needs must be met at all times. Residents must have a drink within reach at all times and an accurate record of food and fluid intake must be kept where residents have nutritional difficulties. Records must be kept to show that all staff have had training in safeguarding vulnerable adults. The proprietors must obtain an up to date copy of the Oxfordshire multi-agency strategy for safeguarding vulnerable adults and ensure that the action they take in response to any allegations are within these guidelines. The infection control policies must be updated to reflect the guidance on Infection Control in Care Homes issued by the Department of Health in 2006. Residents must have individual hoist slings. The deployment of staff must be DS0000046642.V331026.R01.S.doc Timescale for action 31/05/07 31/05/07 3 OP18 13(6) 31/07/07 4 OP26 13(3) 31/07/07 5 OP27 18(1)a 30/04/07 Page 26 Version 5.2 6 OP38 13(5) such that residents are supervised at all times in the temporary lounges. All staff must adhere to safe moving and handling practice. 31/07/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP3 Good Practice Recommendations The proprietors and registered manager should ensure that the home operates within it registration categories and that they are able to meet the needs of residents with dementia, even if that is not the primary reason for their move to the home. The number of falls should continue to be monitored and staff deployment adjusted if necessary to prevent residents coming to harm. The home should ensure that residents have adequate clothing including stockings and socks to help residents maintain their dignity. A choice of meal should be offered at lunch time and the choice be printed on the menus. The home should ensure that residents are sat up in bed and assisted if they are to have supper in bed. The proprietors should review the complaint handling and ensure that they respond in a constructive manner to better meet residents needs and to give relatives confidence that concerns will be addressed. The proprietors and registered manager should ensure that it is possible to verify that the correct checks on staff suitability have been obtained prior to the staff member starting work, to ensure that they are suitable to work with vulnerable people. The proprietors and registered manager should monitor the planned training programme carefully to ensure that it is achieved in a timely way. The proprietor is encouraged to undertake a self-audit of the health and safety arrangements in the home in line with the guidance issued by the Health and Safety Executive on Health and Safety in Care Homes. DS0000046642.V331026.R01.S.doc Version 5.2 Page 27 2 3 4 5 6 OP8 OP10 OP15 OP15 OP16 7 OP29 8 9 OP30 OP38 10 11 OP38 OP38 All staff who handle food should have food hygiene training The Environmental Health Officer should be consulted as to whether the documentation that the home has decided to use complies with the requirements of the ‘Safer Food Handling’ guidance. DS0000046642.V331026.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU 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 DS0000046642.V331026.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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