Inspection on 17/03/08 for Caburn House

This inspection was carried out on 17th March 2008.

CSCI found this care home to be providing an Adequate service.

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

Caburn House 10/03/10

Caburn House 12/03/09

Caburn House 02/05/07

Caburn House 25/04/06

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Caburn House 15 Caburn Road Hove East Sussex BN3 6EF Lead Inspector Jennie Williams Unannounced Inspection 09:00 17 March 2008 th 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 Caburn House DS0000066419.V352407.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. Caburn House DS0000066419.V352407.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Caburn House Address 15 Caburn Road Hove East Sussex BN3 6EF 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) 01273 771945 01273 526795 Vigcare (Caburn) Limited Mrs Barbara Warren Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (0) of places Caburn House DS0000066419.V352407.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Old age, not falling within any other category - (OP) The maximum number of service users to be accommodated is 28. Date of last inspection 2nd May 2007 Brief Description of the Service: Caburn House is a care home providing personal care for twenty-eight (28) older persons. The home is located in a residential area of Hove. The home provides three intermediate care places. Residents who require nursing input receive this from the district nurses. The Registered Providers own several care homes throughout the South of England, predominantly older people services. There are local amenities within walking distance of the home and there is nearby links to public transport. No parking is available at the home; however paid parking is available on the adjacent streets. The residents accommodation is located over three floors. There are five double occupancy rooms that are not provided with en suite facilities. All other rooms are for single occupancy, of which four are provided with en suite facilities (toilet and hand basin). All rooms are used for single occupancy, unless people have chosen to share. There is a passenger shaft lift that services the first floor and stair lifts are available to assist residents to access other floors within the home. There are communal toilets and assisted bathing facilities located throughout the home to meet the needs of the residents. Residents have access to a paved courtyard area. Weekly fees range from £370 to £475 per week. Intermediate care is charged at £400 per week. There are additional fees; hairdressing, chiropody, newspapers/magazines, dry cleaning and personal toiletries (at cost). A full list of additional fees is provided in the Service Users Guide. This information was provided to the CSCI on the 17 March 2008. Prospective residents find out about the home through social services referrals, word of mouth and from themselves/relatives living in the area. Caburn House DS0000066419.V352407.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. It should be noted that following recent CSCI consultation, it was identified that service users prefer to be called people who use services. It was confirmed that the home uses the term residents. For the purpose of this report, people who use the service will be referred to as residents. This unannounced site visit took place over seven hours on the 17 March 2007. Evidence obtained at this site visit and information that the CSCI have received since the last inspection forms this key inspection report. Nine residents were spoken with two others were briefly spoken with due to them involved in other activities. All residents eating in the dining room at lunchtime were met and advised to let the Inspector know if they wished to speak with her individually. Ten resident surveys were sent to the home prior to the site visit, of which eight were returned. Two care plans were briefly viewed. Ten staff surveys were sent to the home prior to inspection, of which six were returned. Two staff were spoken with throughout the site visit. Discussions were also had with the Registered Manager. Four staff files were viewed. A tour of the environment was undertaken and some individual rooms were viewed, with the resident’s permission. Medication procedures were inspected. Results of the last quality assurance surveys were viewed. The handling of complaints to the home was discussed. Procedures for the safe handling of residents monies was checked. An Annual Quality Assurance Assessment (AQAA) was sent to the home prior to the site visit. This was to obtain information about the establishment to assist CSCI in the inspection process. Health and safety records were not viewed as this information has been provided in the AQAA. There were twenty-two residents residing at the home on the day of the site visit. What the service does well: The pre admission process ensures that only residents whose needs can be met at the home are admitted. Residents’ needs are being met with the information provided in the care plans on the assessed needs of individuals. Residents/representatives are provided Caburn House DS0000066419.V352407.R01.S.doc Version 5.2 Page 6 with an opportunity to be involved in the reviewing process to ensure choice and preference is taken into account. Residents’ privacy and dignity are respected. Residents’ lifestyle within the home is their own choice and are provided with opportunities to participate in activities if they wish to. Residents receive a choice of balanced and freshly prepared meals. Residents’ benefit from an open culture where they are able to express their views and feel valued and protected from harm. Residents’ needs are being met with the number and skill mix of staff on duty and are generally safeguarded by the recruitment procedures in place. Resident’s benefit from a motivated and experienced acting manager is continuing to improve many areas within the home. The quality monitoring within the home ensures that the home is run in the best interest of residents. What has improved since the last inspection? Work has been done and is continuing to be done to meet all eight requirements made at the last inspection. This includes: The homes Statement of Purpose and Service Users Guide have been reviewed to provide information relevant to the registered providers. These are given to prospective residents/representatives prior to admission so they can make an informed decision if the home can meet their needs and expectations. Medication procedures within the home have improved, assisting in safeguarding staff and residents. Work has been undertaken and is continuing to be done to ensure all parts of the home are decorated and furnished to a good standard, providing residents with a pleasant environment throughout. The external courtyard has been cleared of all rubbish and furniture is on order to ensure that this area is suitably equipped and maintained for residents to use safely and independently. The use of commodes has decreased and the home has assessed the need to provide sluicing facilities to promote infection control and protect the health and safety of the residents and staff. It was confirmed that this has not been required and environmental health are happy with the arrangements that are currently in place. The need for sluicing facilities will need to be kept under review if the needs of the residents change. Locks on individual room doors have been improved, promoting residents independency to access and leave their rooms. Caburn House DS0000066419.V352407.R01.S.doc Version 5.2 Page 7 Work has been done to improve the bathing facilities within the home to ensure residents’ needs are met. Staffing levels have been improved to ensure there are at all times suitable numbers of staff on duty to meet the needs of residents. External management is becoming more pro active in monitoring their service to ensure the aims and objective are met. 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. Caburn House DS0000066419.V352407.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 Caburn House DS0000066419.V352407.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, 3, 4, 5 & 6 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has information available for prospective residents/representatives on the facilities and services provided to make an informed decision if their needs can be met at the home. The pre admission process ensures that only residents whose needs can be met at the home are admitted. EVIDENCE: It was confirmed that the Statement of Purpose and Service Users Guide have been updated, as required at prior inspections. The home ensures that this information is provided to prospective residents/representatives prior to admission to assist in people making an informed decision if the home can meet their needs. The Statement of Purpose identified that day care is often arranged on a regular weekly basis. On discussion with the Registered Manager following the Caburn House DS0000066419.V352407.R01.S.doc Version 5.2 Page 10 site visit, she confirmed that they do not provide day care and she will ensure this document is amended accordingly. The Registered Manager or deputy manager will undertake the pre admission assessment on all self- funding prospective residents. The home ensures they receive assessments from the social services professionals and reviews the information to ensure needs can be met for all other residents/referrals. These assessments were noted to be in place for newly admitted residents. Assessments are done at the home wherever possible so prospective residents have an opportunity to meet staff and other residents. The AQAA identifies that the pre admission assessment is to be updated within the next 12 months, to incorporate information regarding the Mental Capacity Act. It was discussed with the Registered Manager that when expanding the pre admission assessment form to consider obtaining information to reflect equality and diversity issues. Prospective residents/representatives are encouraged to visit the home prior to moving in wherever possible. The first month is a trial period to ensure the home is able to meet the needs of the individual and that the individual is happy residing at the home. It was confirmed that the contract advises that the first four weeks is the trial period. All resident surveys identified that they received enough information about the home before moving in so they could decide if it was the right place for them. A written comment was ‘ I would rather be able to live at home but as I’m not able no more this is the next best thing to my home’. The Registered Manager confirmed that there was no one residing at the home from any minor ethnic/religious groups with any special cultural or religious needs. The home would access this information should any new resident have any specialist needs. Staff spoken with confirmed that they felt all residents were appropriately placed and all their needs were being met. They confirmed that the Registered Manager takes appropriate action if someone’s needs change and can no longer be met at the home. There are three allocated rooms for intermediate care residents. Any specialist equipment is identified and provided by the various external agencies involved in providing the intermediate support. This includes District nurses, occupational therapist, physiotherapist and speech therapists. The home provides respite care if there is a place available. The Statement of Purpose identifies that emergency unplanned admissions are to be avoided wherever possible. Caburn House DS0000066419.V352407.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 & 10 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents’ needs are being met with the information provided in the care plans on the assessed needs of individuals. Residents/representatives are provided with an opportunity to be involved in the reviewing process to ensure choice and preference is taken into account. Residents are generally safeguarded by the medication procedures in place. Residents’ privacy and dignity are respected. EVIDENCE: The last inspection identified that care plans provided guidance for staff on the assessed needs of each resident and how these needs can be met. Care plans were not viewed in detail, as there were no shortfalls noted at the last inspection and there has been no changes made to the format used. Guidance is provided for staff on the needs of intermediate care residents by the intermediate care team. Caburn House DS0000066419.V352407.R01.S.doc Version 5.2 Page 12 The last inspection identified the system in place for regularly reviewing care plans demonstrated that changes in needs and preferences are recorded. A care plan viewed demonstrated that the same systems are in place. Residents spoken with confirmed that they felt their needs were being met at the home. Some confirmed that staff encourage their independence. Five of the residents surveys identified that they always receive the care and support they need and three identified they usually receive this care. Some written comments received were: ‘I am very happy here’, ‘Staff very good, helpful at all times’. Signatures are obtained from residents/representatives wherever possible to evidence they have been involved in the monthly review. The last inspection report identified the risks faced and posed by residents are assessed, recorded and any actions identified in order to reduce or manage the risk are included in the residents care plan. This process has not changed. Records are maintained of all health professional visits, evidencing residents receive a range of health care intervention. Four of the residents surveys identified that they always receive the medical support they need and three identified they usually receive this support. Staff spoken with felt that there is better communication between the home and the intermediate care team professionals since the last inspection, assisting in all people being made aware of individual needs and providing continuity in care. Two residents observed to be wearing glasses confirmed that the home arranges eye check appointments when required. One resident has recently had new digital hearing aids arranged. It was noted that there are predominantly female carers at the home. Male residents spoken with confirmed that there are no issues with them receiving care from female care staff. Medication Administration Records (MAR) charts viewed demonstrated that medication is generally signed for at the time of administration. There was one incident where a medication had been signed for but not given. Where it is written to administer one or two tablets, not all staff are routinely identifying how many they have administered. No requirement or recommendation has been made in relation to these shortfalls as the Registered Manager can identify staff members responsible and address it with the individuals. It is recommended that all handwritten prescriptions be checked and signed by two staff who have received medication training to further safeguard residents and colleagues from errors occurring. Records are maintained of all incoming and outgoing medicines into the home. Residents are provided with an opportunity to self-medicate if they wish and a risk assessment identifies it is safe for them to do so. Caburn House DS0000066419.V352407.R01.S.doc Version 5.2 Page 13 Records are maintained of controlled drugs. On checking the records and number of controlled drugs being stored, it was noted that for one lot of tablets staff were not counting the number of tablets remaining and appeared to be routinely signing the records. It was identified that there should have been 103 remaining, however only 101 was present in the cupboard. On reviewing the records, one inaccurate recording could be accounted for. The Registered Manager confirmed in writing following inspection that a staff member had confirmed that they had dropped one and did not follow the correct procedures in reporting this. The written information provided evidenced the Registered Manager has been proactive and has addressed this issue with all staff and has arranged refresher training for all staff administering medication. The deputy manager has commenced monitoring controlled drugs on a daily basis. The home noted an error in the dosage of a medicine prescribed to one individual and there was a letter at the home from the hospital congratulating them on picking up this medication error. This evidenced that the administrating staff are pro active and ensure residents are safeguarded and receive correct dosages. Residents confirmed that staff respect their privacy and dignity. Staff were observed to have a good professional rapport with residents and were seen to knock on room doors prior to entering and were heard calling residents by their preferred term of address. All of the resident surveys received identified that the staff listen and act on what they say. It was noted that there is a list of residents names and room numbers by the front door identifying if an individual requires assistance in the event should the home need to be evacuated. The Registered Manager confirmed that the local fire authority liked this idea, however it was discussed that she ensure residents are happy for this information to be on public display or be kept confidentially elsewhere within easy access. Some residents may not want others to know they are residing at the home. The Registered Manager will address this with the residents. Caburn House DS0000066419.V352407.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 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents’ lifestyle within the home is their own choice and are provided with opportunities to participate in activities if they wish to. Residents receive a choice of balanced and freshly prepared meals. EVIDENCE: Residents spoken with confirmed that their lifestyle within the home is their own choice. Residents were observed to move freely within the home on the day of the site visit. There is no activities person employed at the home and care staff provide activities to residents. External entertainment visits the home. Residents surveys identified that there were mixed feelings regarding the provision of activities. When asked if there are activities arranged by the home for them to take part in two identified always and five identified sometimes activities are provided. Written comments from residents identified that keep fit exercises; bingo and videos are some of the activities provided. Caburn House DS0000066419.V352407.R01.S.doc Version 5.2 Page 15 Most residents and staff spoken with felt there were enough activities provided at the home, should they choose to be involved. A written comment from a staff member was ‘there could be more entertainment and more assisted walks in the free time for residents.’ The AQAA identifies that arranging more outings is an area in what they could do better. No requirement or recommendation has been made in relation to this, however management need to ensure they ascertain the wishes of preferences of individuals and take action if it is identified. There are no restrictions for visiting times. Residents confirmed that their visitors can visit at any time and they are able to see them in private. The Statement of Purpose identifies that residents may attend religious services either within or outside of the home as they so desire. Residents spoken with were generally complimentary about the food provided at the home and confirmed that a choice is provided. When asked if they like the meals provided at the home, the surveys identified that three always like the meals, two usually and two sometimes like the meals provided at the home. The cook has a list of residents’ likes/dislikes/allergies to ensure food provided is suitable and within an individual’s choice and preference. The Inspector ate lunch with the residents and it was observed that this is a social time with residents interacting amongst themselves. Staff were observed to be nearby should anyone require assistance. Written comments from residents were ‘Meals are excellent and plenty of choice’, ‘the food is too abundant. I feel sad that so much of it is inevitably wasted’. Work has been undertaken on upgrading the kitchen facilities. The work undertaken was not managed in the best way to safeguard residents. There is now a designated person appointed by the registered provider to monitor health and safety practices within the home. Further information regarding this can be read in the section Management and Administration. An incident report was sent to the CSCI following the registered provider undertaking their monthly visit, where it was identified that the lunch time menu was not being followed and accurate records were not being maintained of the food provided. Information received identified that action was taken to address this and the Registered Manager continues to monitor the documentation. Caburn House DS0000066419.V352407.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 & 18 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents’ benefit from an open culture where they are able to express their views and feel valued and protected from harm. EVIDENCE: Residents spoken with confirmed that they would feel comfortable to raise any concerns and knew who they would speak to. The AQAA identifies that there have been three complaints made to the home within the last 12 months of which none were upheld. There is a complaints record kept at the home. Documentation relating to one complaint was unable to be viewed as the paperwork was still with head office of the organisation. The AQAA identifies that record keeping is an area they have improved in the last 12 months. Six resident surveys identified that they know how to make a complaint. All staff surveys identified that they know what to do if someone raises concerns about the home. It was evident on the day of the site visit that all concerns are taken seriously. A resident was heard advising a care staff member regarding raisins going missing from her room. This staff member reported this to the Registered Manager, who was going to discuss this with the resident. Caburn House DS0000066419.V352407.R01.S.doc Version 5.2 Page 17 Staff confirmed that they are aware of Safeguarding Adults and are clear with the procedures to follow in the event of an allegation being made. The AQAA identifies that arranging more staff training for Safeguarding Adults is an area in which they could do better and plans are in place to continue staff training. The Registered Manager confirmed that staff undertake annual training in Safeguarding Adults. The AQAA identifies that there have been two Safeguarding Adults investigations made in the last 12 months, with both incidents being unsubstantiated. Records were maintained of these allegations. Appropriate action was taken to avoid further allegations being made. One resulted in better communication between the home and the intermediate care professionals. Caburn House DS0000066419.V352407.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 & 26 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents live in a clean and homely environment and work is continuing to ensure residents are provided with comfortable indoor and outdoor communal facilities. EVIDENCE: Residents spoken with confirmed that they were happy with the environment and their individual rooms. Rooms viewed demonstrated that the rooms are personalised to reflect the individual’s choice and character. A tour of the environment was undertaken that demonstrated that the environment is comfortable for residents and there is ongoing maintenance within the service to improve these standards, as required from the last Caburn House DS0000066419.V352407.R01.S.doc Version 5.2 Page 19 inspection. The AQAA identifies that in the last 12 months they have purchased new armchairs, replacing curtains and bedding, providing locks to bedroom doors and improving assisted bathing facilities. The AQAA identifies that improving the standards is an area that will continue in the next 12 months. A staff member confirmed they find the environment warm and friendly and there is sufficient equipment provided to meet the needs of the residents. All rooms are linked to a call bell system to ensure residents are always able to access a staff member. There is no hoist available at the home and discussions were had with the Registered Manager on how a resident is raised from the floor if they were to have a fall. It was confirmed that if the person were injured, an ambulance would be called. Management must realise that ambulance crew follow the homes’ manual handling procedures on entering the premise. Advice needs to be sought and necessary equipment purchased if identified as being needed. There is a paved courtyard that residents have access to. This area has been cleared of rubbish and garden furniture is on order to ensure this area is made user friendly for residents. This is not reflected as an outstanding requirement as action is being taken to ensure this area is suitably equipped. Management must ensure this is completed. Work has been done to improve bathing facilities as required at the last inspection. The AQAA identifies that the bath hoist chair has been made easier to use. There has been a new bathroom suite installed in the second floor bathroom, this bath is not assisted. A walk in shower room is provided on the first floor. The ground floor has an assisted bath. No residents or staff made any comments to the Inspector regarding bathing facilities at the site visit and no issues were identified in the surveys. The home was observed to be clean and free from offensive odours on the day of the site visit. It was required at the last inspection that suitable sluicing facilities be provided. It was confirmed at this site visit and identified in the AQAA that they have assessed whether a sluice machine was necessary, however the use of commodes has reduced and these are sterilised daily. This is not reflected as an outstanding requirement, as the Registered Manager confirmed that environmental health representatives are happy with the current procedures in place. It was discussed with the Registered Manager that the cleanliness under bath hoist seats could be improved. One commode was noted to be old and rusty. Management need to assess the standard of these and replace if required. The AQAA identifies that four staff have received training on the prevention of infection and management of infection control. Four of the residents surveys received showed that the home is always fresh and clean and three identifying it is usually fresh and clean. A written comment was ‘Housekeeping very good’. Caburn House DS0000066419.V352407.R01.S.doc Version 5.2 Page 20 It was observed that hand towels were being used in communal bathrooms. The Registered Manager confirmed that these are changed every day. Having hand towels in communal areas does not promote good infection control. The Registered Manager confirmed that they have already identified this and paper towel dispensers are already on order. Caburn House DS0000066419.V352407.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 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents’ needs are being met with the number and skill mix of staff on duty and are generally safeguarded by the recruitment procedures in place. EVIDENCE: Residents spoke positively about the staff working at the home. Comments ranged from ‘alright’ to ‘very helpful’. A written comment received was ‘I think they are great considering what they have to do in their shift, but always make time for our needs whatever they are’. The Registered Manager confirmed that there are three carers working in the mornings, two in the afternoon and two staff working a waking night. The Registered Manager is also on duty during the week day times until 5pm. Since the last inspection, a new kitchen assistant and supper cook has been employed to provide more time for care staff to undertake care duties. Care staff continue to wash the laundry, however it was confirmed that this does not impact on the time they require to care for residents. Residents and staff all confirmed that they felt there were sufficient numbers of staff on duty to meet the needs of the residents. For those who felt sometimes there weren’t enough confirmed that someone was always available when they Caburn House DS0000066419.V352407.R01.S.doc Version 5.2 Page 22 needed assistance. If agency staff are used, the home requests people who have worked at the home on previous occasions to promote continuity of care. Staff spoken with and staff surveys demonstrated that they are generally happy working at the home. Negative comments were related to the rates of pay, which does not fall within the CSCI’s remit. Written comments from staff identified that there was good teamwork within the home. Two staff commented ‘the rota changes from week to week so we have varied days and not stuck to one set of hours each week’. Recruitment files viewed demonstrated that residents are generally safeguarded. One person only had one reference, however the Registered Manager is already addressing this shortfall. Enhanced Criminal Record Bureau (CRB) were seen to be in place and staff have at least a Protection of Vulnerable Adults (POVA) First check in place prior to commencing work. It was confirmed that staff commencing work on a POVA First check are supervised until the CRB is returned. This may be difficult when only two staff are on duty. Records are maintained of any disciplinary action that may be required. The home is working towards ensuring that at least 50 of care staff obtains National Vocation Qualification (NVQ) level 2 or above. Two staff have completed NVQ level 2, four are enrolled to undertake these studies and three staff have enrolled to complete NVQ level 3. The Registered Manager confirmed that all staff are up to date with mandatory training and other training relevant to the staffs’ role is arranged when identified. The home has implemented new training profiles/assessments for staff that assists in identifying training needs. These assessment tools have been developed by Skills for Care. The Registered Manager confirmed that the induction in place for new staff complies with the expectations set by the Skills for Care. Staff spoken with and staff surveys all identified that they are provided with suitable training opportunities. All staff surveys confirmed that they are given training that is relevant to their role, helps them to understand and meet the individual needs of residents and keeps them up to date with new ways of working. Caburn House DS0000066419.V352407.R01.S.doc Version 5.2 Page 23 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 & 38 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents benefit from a motivated and experienced Registered Manager who is continuing to improve many areas within the home. External management is becoming more pro active in monitoring their service to ensure the aims and objectives are met. Health and safety procedures need to be more robust to further safeguard residents’ health, safety and welfare. EVIDENCE: The Registered Manager is registered with the CSCI and has the suitable skills and experience to manage the service. She has been working at the home for 18 months and has completed NVQ level 4 in care and has completed the Caburn House DS0000066419.V352407.R01.S.doc Version 5.2 Page 24 Registered Manager Award course. She confirmed that she finds external management supportive and she has more ‘freedom’ to make decisions with some aspects of running the service. ie. Staffing levels. Staff spoken with confirmed that the Registered Manager is supportive and approachable and there are clear roles and responsibilities within the team. They have had no dealings with management external to the home. The Registered Manager confirmed that there are clear roles and responsibilities within the home and with external management. This home has been involved in management review meetings as part of the CSCI improvement and enforcement agenda. These were related to all the services owned by the registered providers/Responsible Individual. Warning letters have been sent and meetings have also been held with the registered providers to remind them of their legal obligations to ensure the services they provide meet the aims and objectives of the service and their Statement of Purpose. The provider responded to the specific warning letter relating to Caburn House. Improvements are being made and the registered providers have employed a trainer and a consultant to assist them in meeting their legal obligations. Regulation 26 visit reports from the registered provider were available at the home for viewing. In light of the concerns the CSCI had in respect of the current level of supervision within the home and the registered providers not monitoring their services, it had been advised that these reports be forwarded to the CSCI on a monthly basis. Management have also been reminded of their legal obligations to inform the CSCI of significant events that may occur within the home. This sharing of information has improved. Management meetings are held between all managers of the homes owned by the registered providers/Responsible Individual where documentation and ideas are shared. An AQAA was completed as required, however discussions were had with the Registered Manager on how information could be expanded to provide more detailed evidence. There is a quality assurance and quality monitoring system in place to assist the Registered Manager in ensuring the home is run in the best interest of residents. Intermediate care residents are asked to complete a survey following their stay within the home. The Registered Manager confirmed that residents are asked to complete a survey twice a year and these are read and actioned wherever needed. Resident and staff meetings are held every three months. Feedback is sought from visiting health professionals. These results are shared with staff and residents. It was discussed with the Registered Manager ways in which these results could be displayed so all interested stakeholders can access this information. Staff are able to voice their thoughts Caburn House DS0000066419.V352407.R01.S.doc Version 5.2 Page 25 at any time, however it was discussed with the Registered Manager ways in which staff should be provided with the opportunity to have their say anonymously. The Registered Manager thought it a good idea to implement staff surveys. A written comment from the homes quality assurance surveys was ‘ I like the friendliness of the kindness at Caburn House and all the staff’. The home holds small amounts of personal allowance for residents. Records are maintained of all financial transactions and receipts are obtained wherever possible. Individuals monies are stored collectively, however individual records are maintained. The AQAA identifies that equipment in use is serviced or tested as recommended by the manufacturer or other regulatory body. Door closures have been fitted to doors where an individual may wish their room door to remain open during the day. The Registered Manager confirmed that the local fire authority undertook an inspection of the service and there were no shortfalls. Staff receive fire training and participate in fire drills. There were bottles of cleaning fluid being stored unlocked in a communal bathroom, which could pose a hazard to residents. The Registered Manager confirmed that they should not be stored there and will address this with the staff involved and ensure they are stored securely. There were free standing heaters observed in some individual rooms. The Registered Manager needs to ensure risk assessments are in place for the use of these and ascertain if they are required and do not pose an additional risk to the residents. An en suite window was noted not to be restricted. It was recommended that this be restricted to safeguard residents from unauthorised people entering the home. Work has been undertaken on upgrading the kitchen facilities. Half the kitchen has been upgraded to date. The work undertaken was not managed in the best way to safeguard residents. This resulted in environmental health serving notices on the home. There is now a designated person appointed by the registered provider to monitor health and safety practices within the home. Caburn House DS0000066419.V352407.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 3 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 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 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Caburn House DS0000066419.V352407.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP38 Regulation 13(4) Requirement That the home undertakes a comprehensive environmental health risk assessment to ensure the home is free from hazards. Timescale for action 20/05/08 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 OP9 Good Practice Recommendations All handwritten prescriptions should be checked and signed by two staff who have received medication training to further safeguard residents and other colleagues. Caburn House DS0000066419.V352407.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Caburn House DS0000066419.V352407.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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!