Inspection on 04/06/07 for Candle Court Care Home

This inspection was carried out on 4th June 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Candle Court Care Home 23/05/06

Candle Court Care Home 01/12/05

Candle Court Care Home 07/06/05

Candle Court Care Home 25/11/04

Candle Court Care Home 06/07/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Townley Road, 2-3

Orchard House Nursing Home

St Josephs Rest Home

Foxley Lane (121a)

Tudor Lodge

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

CARE HOMES FOR OLDER PEOPLE Candle Court Care Home Bentley Drive Off Cricklewood Lane London NW 2 2TD Lead Inspector Tom McKervey Key Unannounced Inspection 10:00 4 & 5TH June 2007 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 Candle Court Care Home DS0000053368.V336907.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. Candle Court Care Home DS0000053368.V336907.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Candle Court Care Home Address Bentley Drive Off Cricklewood Lane London NW 2 2TD 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) 0208 731 7991 0208 731 7992 Rockley Dene Homes Limited Lynette Joyce Levy Care Home 93 Category(ies) of Dementia (14), Dementia - over 65 years of age registration, with number (0), Mental disorder, excluding learning of places disability or dementia (18), Mental Disorder, excluding learning disability or dementia - over 65 years of age (0), Old age, not falling within any other category (0) Candle Court Care Home DS0000053368.V336907.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care Home with Nursing - Code N to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old Age, not falling within any other category - Code OP Dementia - Code DE (maximum number of places: 14) and Code DE(E) Mental Disorder, excluding Learning Disability or Dementia - Code MD (maximum number of places: 18) and Code MD(E) The maximum number of service users who can be accommodated is: 93. 23rd May 2006 2. Date of last inspection Brief Description of the Service: Candle Court is a nursing home for people with mental health needs, including dementia. The home is owned and managed by Rockley Dene Homes Limited, a company based in Harrow, Middlesex. The company also owns three other care homes elsewhere in the U.K. The home was registered with the Commission for Social Care Inspection in April 2004. The home provides nursing care and support for 93 people of either gender over the age of 65. The residents are accommodated on two floors, each with its own staff team. Fifty-six residents live on the ground floor and thirty-seven on the first floor. Each floor is sub-divided into three named wings. The two-story building has a rectangular structure with an attractive central courtyard, which is accessible by all the residents. Each floor has its own bathrooms, toilets, lounge, dining room and small kitchen areas. There are 59 single and 17 double bedrooms with en-suite facilities. Candle Court Care Home DS0000053368.V336907.R01.S.doc Version 5.2 Page 5 The basement of the premises contains a large and a small kitchen, a laundry area, staff changing facilities and a staff training room. Two passenger lifts service the ground and first floors. Candle Court is situated near a busy junction between Cricklewood Lane and the A41. The home is easily accessible by public transport and there are shops and other amenities within walking distance on Cricklewood Lane. The homes stated aims are to provide long-term personal and nursing care, to 93 older people of both genders, over the age of 65 suffering from dementia, enduring mental health problems and physical disability. The fees for the service range from £590 to £900 per week. The fees do not cover hairdressing, newspapers and chiropody. Following Inspecting for Better Lives, the provider must make information about the service, including inspection reports, available to service users and other stakeholders. Copies of this report are also available on the Commission for Social Care Inspection website. Candle Court Care Home DS0000053368.V336907.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out over two days and took eleven hours to complete. The visit was part of the Commission’s inspection programme and to check compliance with the key standards. The manager and deputy were present during both days of the inspection and fully cooperated in the process. I had a discussion with the manager before the inspection started, during which she informed me that she had just submitted her resignation and would be leaving within a few weeks. It has been arranged for the deputy manager to take charge of the home until a new manager is appointed. I visited all areas of the home, including several bedrooms. I also read residents’ and staffs’ files, and examined various documents relating to the management of the home. At the time of the inspection, there were eighty-three people living in the home and there were ten vacancies. Fourteen residents, eight relatives and seven staff were interviewed during the inspection about their views and experiences of the service. These interviews were carried out independently of the managers. It was not possible to converse with the majority of the residents because of their mental capacity. However, I was able to speak to some of the people living in the home, and through observing how staff interacted with the residents and cared for them, it was possible to form conclusions about the quality of the service. At the time of the inspection, a member of staff had recently died suddenly, which caused some distress among the staff. I wish to extend my sincere condolences to the staff’s family and the staff group at Candle Court. What the service does well: Relatives are generally complimentary about the service and have confirmed this in letters and cards. The quality of the environment is very good, very clean, and there are good systems in place to ensure that the home is safe for people to live in. People undergo a thorough assessment of their needs before being admitted to the home and there is an open visiting policy for friends and relatives. Candle Court Care Home DS0000053368.V336907.R01.S.doc Version 5.2 Page 7 Each person who lives in the home has a care plan that identifies their needs and staff provide personal care in a manner that respects the dignity of the residents. The quality and range of the meals is satisfactory and staff support residents who need help with eating in a sensitive manner. The home consistently logs and responds to complaints and staff are trained in the protection of vulnerable adults. There are enough staff on duty to meet the needs of those living in the home and new staff are thoroughly screened before they start work at the home, which protects the residents’ welfare. The service puts a high level of importance on training to meet the needs of people using the service. The manager is competent to run the home and there are good contingency arrangements in place for the management of the home when she leaves. The home meets health and safety requirements and the quality of the service is also monitored regularly by senior managers. What has improved since the last inspection? The catering service for residents on the first floor has been reviewed and altered to ensure that food is provided in the way that residents’ prefer, and more crockery has been provided. Steps have been taken to ensure that all complaints about the service are recorded. The maintenance and repair issues identified at the last inspection have been put right and old faulty wheelchairs have been removed. Sandbags that were placed outside a fire exit have been removed to ensure that the exit is clear. Staffing levels have been adjusted so that sufficient staff are available when residents’ needs are highest. Staff meetings are being held to enable staff to put forward their views about the service. Candle Court Care Home DS0000053368.V336907.R01.S.doc Version 5.2 Page 8 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. Candle Court Care Home DS0000053368.V336907.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Candle Court Care Home DS0000053368.V336907.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4 & 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A thorough assessment of needs is carried out before and at the time a person is admitted to the home. The majority of residents and their relatives are satisfied with the care that is provided, and they are able to visit the home prior to moving in. EVIDENCE: I examined a sample of five residents’ case files, four of whom had been admitted to the home recently. Candle Court Care Home DS0000053368.V336907.R01.S.doc Version 5.2 Page 11 The home was purpose-built in 1996. all areas of the home are accessible by wheelchair users, and all bedrooms have en-suite facilities. The home has closed circuit television and a protected entry system to ensure safety, as does each floor where the residents live. The home is registered to provide care for people with mental health needs, the majority of whom have dementia, and qualified mental health nurses are on duty at all times. Many staff have been trained in dementia care. The records included a full assessment of the person’s needs by health and local authority care managers and senior staff from the home. The assessment covered physical and mental health, communication, skin status and mobility needs. The majority of places in the home are funded by local authority block contracts. At the time of the inspection, there were ten vacancies and the manager told me that the company is considering dedicating a section of the building for accommodating a younger clientele who have early onset dementia. The home’s Statement of Purpose, which is available in large print, has been updated to include this information. People who live in the home and relatives who were spoken to (with one exception), stated that they were satisfied with the care provided. The relatives confirmed that they were able to visit the home to assess its ability to meet service users needs. Candle Court Care Home DS0000053368.V336907.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a plan of care that identifies the needs of each person who lives in the home. There is evidence of health care treatment and intervention in the residents’ care plans, and staff provide personal care that respects the dignity of those living in the home. Medication records are generally good, but there are some discrepancies in recording, which could residents at risk. EVIDENCE: Candle Court Care Home DS0000053368.V336907.R01.S.doc Version 5.2 Page 13 I sampled five case files. They contained an individual care plan for each resident, which was reviewed on a monthly basis. The care plans reflected the assessed needs and the person’s likes and dislikes. There was guidance for staff about how to minimise challenging behaviours by appropriate interventions; for example taking the person for a walk if they become restless or distressed. Each resident is assigned a key worker who is responsible for monitoring the care plan and recording any changes. Various assessment tools are used in the care plan, for example, Waterlow and Braden scales for incontinence and the risk of pressure ulcers, and sleep charts were being used for residents who were restless during the night. Other risk assessments had been done about mobility and behaviour, with guidance for staff about how to support the resident appropriately. I noted that one person who was confined to bed had a chart that showed the frequency of changes in their position to prevent pressure ulcers. Residents’ records indicated that they were seen regularly by the G.P and a range of other healthcare professionals, including dentists and chiropodists. Two consultant psychiatrists are responsible for all the residents and they visit regularly to monitor care and review residents’ medication. There is always a qualified nurse on duty in the home. The residents generally appeared well cared for. I observed a resident who had a coughing fit being immediately attended to by a member of staff who brought a drink of water and reassured the resident. Several male residents were wearing jogging bottoms and when I spoke to the manager about this, I was told that relatives tend to bring these to the home for the resident to wear, especially if they are incontinent. I noted that residents were taken to the bathroom/toilet frequently during the day and personal care was given in private with the door closed. I noted that a resident had some facial bruising. I was informed that this person had been found on the floor of another resident’s room the previous night. It was not known how the injury was caused. On looking at the records, the incident had been logged in the night report but not entered in the accident book. A requirement is made under Standard 37 for staff to record all accidents in the accident book. Candle Court Care Home DS0000053368.V336907.R01.S.doc Version 5.2 Page 14 With the above exception, I was satisfied that accidents are usually recorded in the accident book and information is provided about the action taken, for example referring to the G.P or A&E department as appropriate. One resident’s relative I spoke to, had serious concerns about the care provided by the home and had recently made a formal complaint. I assured the relative that his complaint would be investigated thoroughly and responded to promptly. There are ample hoists and special equipment to support residents with mobility problems and I did observe several staff using these aids appropriately. However, not all staff have been trained in moving and handling techniques. Another visitor said they were generally satisfied with the care but said that sometimes staff appeared “a bit rough” when helping residents to sit up or stand. I observed that there were several residents with bruising which could be associated with poor handling technique. Both these issues are addressed in the Management Standards section of the report. There are five staff working at the home who are accredited to train other staff to properly support residents when moving them. However, one staff who had worked at the home for two years, told me they had never been trained in moving and handling. Training in this subject is mandatory and a requirement is made under Standard 38 to address this issue. I examined the medication records and I found that in one instance, a staff’s signature had been obliterated with correction fluid, and in another incident, staff had not signed for a medication. I have made a requirement about this matter; otherwise I was satisfied that the administration of medicines was satisfactory. Candle Court Care Home DS0000053368.V336907.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some group activities are provided for the enjoyment of the residents, but there is a lack of stimulating individual interaction between staff and residents who have dementia. The visiting arrangements are good and religious and sexual preferences are respected. Residents who have the ability to make choices are supported in doing so by the staff, but this could be improved by providing menus on each floor. The food is of satisfactory quality and staff sensitively support residents who need help when eating. EVIDENCE: Candle Court Care Home DS0000053368.V336907.R01.S.doc Version 5.2 Page 16 There has been no activities organiser in the home for more than a year and some staff commented that they missed having a person in this post. An afternoon session by an outside entertainer was held on the last afternoon of the inspection, which was thoroughly enjoyed by the residents. I was informed about other joint activities, for example, Bingo, but over the two days of the inspection, I noted only a few occasions when a one-to-one activity took place between staff and residents. This was disappointing in view of the fact that the company has invested in training many staff in dementia care, which focuses on stimulation and communication needs of people with dementia. A requirement is made about this issue. I spoke to two residents who said that the staff respected their preference to spend most of their time in their rooms watching television, listening to the radio and reading. Two other residents go out most days, spending time in the local community. There were records of some residents going out to church and of regular visits to the home by ministers of religion. I was informed that there are plans to convert a bathroom to a beauty salon. There are frequent visitors to the home at various times during the day and evening, which are recorded in a visitors’ book in the entrance. The visitors I spoke to, said they were always warmly welcomed by the staff. Comfortable seating is provided in the reception area for visitors and they can also visit residents in their rooms. Provision is made for couples who are gay to share a room. Both floors have dining areas that are pleasantly decorated and newly furnished. The menus that were seen in the kitchen, showed that there was a good variety of nutritious food provided, including fresh fruit. Staff told me that food presentation had improved and sufficient crockery was available since the last inspection, particularly for people on the first floor. I observed two residents being asked about what they would like to eat. However, when I asked other residents and staff what was for lunch that day, they did not know because a menu was not available on either floor. This could Candle Court Care Home DS0000053368.V336907.R01.S.doc Version 5.2 Page 17 affect residents’ ability to choose an alternative and therefore, a requirement is made to address this issue. An inspection of the kitchen showed that good hygiene procedures were in place, and catering staff had been trained in handling food properly. Supplementary dietary products are provided for residents who have difficulty swallowing and those who are underweight. I noted that there was good practice by staff in supporting residents who required assistance to eat, by not hurrying and sitting at the same level. I observed visitors bringing food in for their relatives that they particularly liked. Candle Court Care Home DS0000053368.V336907.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home keeps records of all complaints and, unless there are exceptional circumstances, responds within the agreed timescale. Residents are safeguarded from abuse by appropriate procedures and staff being trained in abuse awareness. EVIDENCE: Four complaints were logged in the past year. One of these complaints had been partly substantiated and another is still awaiting resolution. A strategy meeting involving local authority and health professionals had been held under the Protection of Vulnerable Adults procedures following one of these complaints. The outcome was that the complaint was partly substantiated, but the home was deemed to have followed correct procedures and taken appropriate action. Candle Court Care Home DS0000053368.V336907.R01.S.doc Version 5.2 Page 19 Another complaint had been lodged recently. I met this complainant during the inspection and informed him that the company will carry out an investigation under its procedures and provide a response in a reasonable timescale. With this exception, relatives who were spoken to, said they were satisfied with the service, but if necessary, they knew how to make concerns known. The deputy manager is an accredited trainer in adult protection, which authorises her to train staff in these procedures. A training programme was currently underway. The staff that were spoken to, were knowledgeable about their responsibilities to report suspected abuse of service users. There is a book in the reception area for people to comment on the service. The following are examples of the comments: “I am short of words to express my gratitude to the whole team who care for my mum”. Everyone is pleasant and helpful and I know the work isn’t easy. Thanks you for looking after my husband”. “I was reluctant to let my husband go into a care home but am truly thankful that he was admitted to Candle Court. It is a privilege to see staff working together hiving loving care to all the residents. If every home operated as well as Candle Court, there is little to worry about care of the elderly”. Candle Court Care Home DS0000053368.V336907.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 23 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a well-maintained environment that is appropriate for the specific needs of the people who live there. One double room does not have a screen to protect the dignity and privacy of the people who share, and another double room is too small for two people, particularly wheelchair users. The home is very clean and smells fresh and there are good procedures for control of infection. EVIDENCE: Candle Court Care Home DS0000053368.V336907.R01.S.doc Version 5.2 Page 21 I carried out a tour of the exterior and interior of the building, including the majority of the bedrooms. The front aspect of the building is pleasant, with well-maintained shrubs and handing baskets. The company employs a full-time maintenance person, who is also responsible for the company’s other homes.The building is generally well maintained and there are good records of repairs and health and safety checks. The standard of décor throughout the home was very good and I was satisfied that the repair/maintenance issues identified at the last inspection, had been addressed satisfactorily. The maintenance person who visits the home twice weekly, was present during this inspection and immediately attended to some minor repair issues that I brought to his attention. The staff are expected to log any repair issues in a maintenance book, which are picked up by the maintenance person, but I was informed that staff sometimes fail to do this. The following deficits were identified at this inspection; The armchairs in the upstairs lounge are old and torn in places and should be replaced. • Bedroom FB31; there was a broken drawer in the chest of drawers. • Room 1, first floor; there was no screen, although this is a double room. Requirements are made to address these issues. I was informed that Room 3 is designated as a double room, although it is currently occupied by only one person. A recommendation is made that consideration be given to keeping this as a single room, because it appears too small to be a double, especially for a wheelchair user. The majority of bedrooms had photographs of residents on the doors to aid their orientation, and there was evidence of personal possessions that residents had brought with them to personalise their rooms. The manager informed me of her concern about the state of cleanliness in one resident’s room. Apparently, the resident refused to allow staff in to clean the room. I visited this person and found that the room was extremely untidy and overcrowded, with clothes piled on the floor and old food and drink containers lying around. • Candle Court Care Home DS0000053368.V336907.R01.S.doc Version 5.2 Page 22 I informed the manager that although the resident chose to live in this condition, they should be reminded about the terms and conditions of their occupancy. The state of this room poses a serious risk to this person, the staff and the other residents. A requirement is made to address this issue. There are sufficient hoists, special baths and grab rails in the home to assist residents with mobility problems. The specialist equipment is regularly serviced to ensure its safety. There is a team of cleaners in the home, and at the time of the inspection, the home was very clean and smelled fresh and pleasant. There is a control of infection procedure in place and a contract for disposal of clinical waste. Staff were seen wearing disposable gloves and aprons when supporting the residents with their personal care. Candle Court Care Home DS0000053368.V336907.R01.S.doc Version 5.2 Page 23 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): All these standards were assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are consistently enough staff on duty to meet the needs of those living in the home, with more staff being available at peak times of activity. There is a good recruitment procedure to ensure that residents’ welfare is safeguarded. The service puts a high level of importance on training and staff report that they are supported through training to meet the needs of people using the service. EVIDENCE: The staff rota showed that there was always a qualified nurse on duty day and night on each floor. The number of staff on duty meets the London Staffing Guidelines, and staff told me that, following the last inspection, the allocation ensures that there is Candle Court Care Home DS0000053368.V336907.R01.S.doc Version 5.2 Page 24 sufficient numbers of staff on duty at peak times, when many residents required personal support and help with meals. No agency staff are employed and any vacancies are covered by a bank system, which enables continuity of care. There is a team of cleaners and catering staff to support the care staff. All new staff have an induction to the home, which is aligned to “Skills for care induction”. There is also an extensive training and development programme for all staff, which includes, National Vocational Qualification levels 2 & 3, health and safety, tissue viability, wound care and dementia care. Staff said they appreciated the amount of training they received. However, as noted above under the Healthcare and Personal standards, not all staff have received manual handling training yet. I examined the records of six new staff. The records showed that they had been recruited by application for posts, interviews, and had been properly screened by Criminal Records Bureau checks and references. All staff have contracts of employment and up to date job descriptions, and staff meetings are planned to take place regularly. Candle Court Care Home DS0000053368.V336907.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 36, 37 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager has the required qualifications and experience and is competent to run the home. There are good contingency arrangements in place to manage the home when the current manager leaves. The home has a consistent record of meeting health and safety requirements and legislation relating to the installations and equipment in the home. There is evidence of organisational monitoring of service quality by the company. There is inconsistent supervision of staff with infrequent individual sessions to monitor performance and discuss work issues. Candle Court Care Home DS0000053368.V336907.R01.S.doc Version 5.2 Page 26 Staff are not being consistently trained in proper moving and handling techniques, which could result in injury to themselves and the residents. EVIDENCE: The manager, who is a registered nurse, has been in post since November 2006, and is registered with the Commission for Social Care Inspection. She holds the Certificate in Dementia Care. However, the manager informed me that she had just tendered her resignation and would be leaving the home. There is a deputy manager, who has very good experience she will take charge of the service until a new manager is appointed. There are two senior nurses on the ground and first floors respectively. Verbal feedback from relatives, as well as letters and cards, and feedback from staff, indicated that there was confidence in how the service was run and there was good morale among the staff team. The home conducted a quality assurance audit in the past year, which showed a high level of satisfaction with the service. A director and/or the proprietor carry out unannounced monthly visits to the home and copies of their reports are sent to the Commission for Social Care Inspection. An accident that occurred to a resident had not been recorded in the home’s accident book and I identified two discrepancies in the administration of medicines records. Requirements are made to address these issues. At the last inspection, a requirement was made for a programme of staff supervision be implemented. This had still not taken place, but the manager said this was about to start and I was shown a proforma that will be used in the process. This requirement is restated. I was concerned about two incidents when residents were being moved in wheelchairs without foot rests being used. Not all staff have been trained in moving and handling techniques. This could pose a risk of injury to staff and residents and requirements are made to address this. Candle Court Care Home DS0000053368.V336907.R01.S.doc Version 5.2 Page 27 Otherwise, there were good records of health and safety checks for all gas, fire electrical and water installations. Hoists and lifts were regularly serviced, and fire alarms were tested and drills carried out. A fire risk assessment had been done and an emergency plan was in place in the event of a serious incident. Candle Court Care Home DS0000053368.V336907.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X 3 3 X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X 2 2 2 Candle Court Care Home DS0000053368.V336907.R01.S.doc Version 5.2 Page 29 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 OP9 Regulation 13(2) Timescale for action All medication that is 30/06/07 administered must be accurately recorded. Correction fluid must not be used to correct errors in the records of administration of medicines. Staff must engage residents in 31/07/07 individual activities that are stimulating and enhance their communication. Menus must be made available 31/07/07 to staff and residents on each floor to enable them to make choices about their meals. The following maintenance and 31/08/07 repair issues must be attended to: • The armchairs in the upstairs lounge that are old and torn must be replaced. the broken drawer in the chest of drawers in bedroom FB31 must be repaired or replaced. A screen, must be provided in Room 1, first floor if this is to be used as a double Version 5.2 Page 30 Requirement 2. OP12 16(2)(n) 3. OP15 12(2) 4. OP19 23(2) • • Candle Court Care Home DS0000053368.V336907.R01.S.doc room. 5. OP26 16(2)(j) A specific resident’s room must 30/06/07 be cleared of old food and drinks and the room must be cleaned and tidied to prevent the risk of infection. . Staff must receive at least six 31/07/07 formal supervisions a year, to support them in their roles as carers. This requirement is restated from the last inspection. The previous timescale for this requirement was 31/12/06. 7. 8. 9. OP37 OP38 OP38 17(1)(a) Sch 3 13(5) 13(5) A record of all accidents in the 30/06/07 home must be recorded in the accident book. Footrests must always be used 30/06/07 when moving residents who use wheelchairs. All staff must be trained in 31/07/07 moving and handling techniques. 6. OP36 18(2) 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 OP23 Good Practice Recommendations Consideration should be given to keeping Room 3 as a single room, because it appears too small to be a double, especially for a wheelchair user. Candle Court Care Home DS0000053368.V336907.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA 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. 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