Inspection on 08/08/06 for Carl Court

This inspection was carried out on 8th August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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

Carl Court 25/07/07

Carl Court 17/11/05

Carl Court 21/07/05

Carl Court 16/11/04

Carl Court 23/06/04

Carl Court 04/03/04

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Stallcombe House

Belma

Hunters Care Centre

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

CARE HOMES FOR OLDER PEOPLE Carl Court Carl Court Guestland Road Cary Park Torquay Devon TQ1 3NN Lead Inspector Judy Cooper Unannounced Inspection 10:15 8 August 2006 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 Carl Court DS0000018334.V293319.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. Carl Court DS0000018334.V293319.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Carl Court Address Carl Court Guestland Road Cary Park Torquay Devon TQ1 3NN 01803 329203 01803 329203 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) Mr Farzand Mungar Mrs Kim Hioh Mungar Mr Farzand Mungar Care Home 15 Category(ies) of Dementia - over 65 years of age (15), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (15), Old age, not falling within any other category (15) Carl Court DS0000018334.V293319.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service Users with Mental disorder may be admitted from 50 years age Service Users with Dementia may be admitted from 50 years age Date of last inspection 17th November 2005 Brief Description of the Service: Carl Court provides accommodation with personal care to older people (65 ), older people with mental disorder and older people with dementia (from the age of 50). The home is registered for up to fifteen residents both male and female. Bedroom accommodation is provided over two levels with there being a stair lift in place for those with mobility problems. There remain four steps that need to be negotiated, where the chair lift finishes, to allow residents access to the home’s first floor. There are fifteen single rooms, ten of which have en suite facilities. In terms of communal space, Carl Court offers two lounges and a dining room. There is also an easily accessible, secure and attractive garden. The building itself is a large detached property that is almost adjacent to a public park and located in the St. Marychurch area of Torquay. Local shops and amenities are within walking distance of the home, with Torquay town centre a bus ride away. Fees range from £293.97 to £316.28 per week. Carl Court DS0000018334.V293319.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This site visit took place on Tuesday 8th August between 10.15a.m. and 5.30 p.m. Opportunity was taken to observe the general overall care given to current residents. The care provided for three residents was also followed in specific detail, from the time they were admitted to the home, which involved checking that all elements of their identified care needs were being met appropriately. A tour the premises, examination of some records and policies, discussions with the two owners, residents (who were able to converse) and staff on duty, as well as one visitor to the home, also formed part of this inspection, whilst staff on duty were observed, in the course of undertaking their daily duties. Other information about the home, including the receipt of several completed questionnaires from staff, and other interested parties, including outside professionals, has provided further feedback as to how the home performs. This collated information has been used in the writing of this report. All required core standards were inspected during the course of this inspection. What the service does well: Carl Court DS0000018334.V293319.R01.S.doc Version 5.2 Page 6 Carl Court provides excellent personal care and support for all the residents at the home. This includes older people, and those from the age of 50-65 who may have dementia or a mental health need. One of the owners is a qualified mental health nurse (although her nursing registration has since elapsed) and she has also completed her registered manager’s award, whilst both have substantial experience in managing a care service, having owned and run Carl Court for the past fifteen years. Both owners are present in the home most days and form additional support to care staff as well as being fully aware of the care needs of the residents at the home. Carl Court is well maintained, exceptionally clean and offers accommodation in a comfortable and homely way. The home has an attractive garden that is accessible and has been designed with safety in mind. The garden also contains an aviary and a fishpond. Residents continue to state that staff are very caring and helpful. Residents were observed to be relaxed and staff were noted as being very attentive towards them and understanding of their individual’s needs. A very relaxed, family atmosphere is maintained within the home, for which the owners and staff should be commended. The owners and staff provide very individual care for the residents, some of whom are unable to communicate their needs. The owners and staff are aware of this and ensure the care provided matches the residents’ needs and personal preferences as far as they are able to ascertain. One of the home’s main strengths is the way that the staff upholds the residents’ dignity and their rights to make personal choices. Due to the categories of the resident group that continue to be cared for at Carl Court (i.e. many residents suffer from advanced dementia or mental health illness), it means that staff need to take time and use good observational skills to determine what a resident may be trying to communicate, and these skills were seen to be an integral part of the staffs’ role within the home. Carl Court DS0000018334.V293319.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: Staff supervision meetings must be recorded, as evidence that these meetings take place and to show how the owners are enabling the staff to further develop their caring skills and how they will provide additional support for staff as required. Carl Court DS0000018334.V293319.R01.S.doc Version 5.2 Page 8 The remainder of radiators in the home, not already protected or provided with low temperature surfaces, must be guarded or replaced with low surface temperature radiators in order to protect all residents from being placed at risk of sustaining a burn, should a residnt fall against a radiator. Hot water, provided to residents’ wash hand basins, should be regulated to a safe temperature (approximately 43 degrees centigrade) to prevent the risk of scalding for a resident when using their own facilities. (Communal baths, within the home, have already been fitted with valves to provide the required regulated water temperature). Details regarding the fire awareness training given to staff, along with the names of the staff who have attended, must be readily available within the home. The owners must also ensure that the home’s fire precautions are in line with the requirements of the local fire and rescue service, in so far as providing staff training at the required intervals and ensuring a visual check of the home’s fire extinguishers takes place on a monthly basis. The owners should consider having an assessment of the premises and facilities undertaken by a suitably qualified person, including a qualified occupational therapist to allow a qualified person to give a full assessment of the premises and indicate what could be improved upon, environmentally. The owners need to formalise the home’s quality assurance programme, and evidence that they are seeking the views of residents (where able) and/or their families/advocate as well as other professionals, to allow the owners to be aware of any area that could be further developed to be in the resident’s best interests. 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. Carl Court DS0000018334.V293319.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 Carl Court DS0000018334.V293319.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (6 is not applicable). The quality in this outcome area is good. The home only admits residents whose needs have been appropriately assessed and where it is felt these needs can be met. EVIDENCE: Since the last inspection the home has only admitted one new resident. Following discussion with the owners, and observing documentation in relation to the admission process associated with this resident, it could be concluded that the admission had been undertaken in such a manner as to ensure the management of the home were clear that the home could provide appropriate care for the resident. The admission process for the other two residents was also looked at. One resident had been at the home for three years and clearly felt that their care needs were being met at Carl Court and was very comfortable in the home their comment being: “I have lived in other places and this is the best”. The third resident’s admission that was discussed was also noted to have been carried out appropriately. Carl Court DS0000018334.V293319.R01.S.doc Version 5.2 Page 11 This was also confirmed by the resident’s next of kin who happened to be visiting at the same time as the inspection and so was able to give a full account of the both the admission process and the subsequent care provided to the resident. She stated she was made aware of what care would be available for her relative at the home, prior to the admission, and that the subsequent care provided had indeed met her relative’s needs. The home’s statement of purpose was available, with the owner currently in the process of updating it to reflect the recent staff changes that have occurred at the home. Up to date Social Services contracts were in place for all of the residents whose care was looked at. The home also provides its own contracts for any private clients and a copy of this was seen and it was noted that the contract contained appropriate information, which clearly stated the terms and conditions operating within the home. The home does not provide an intermediate care service. Carl Court DS0000018334.V293319.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 The quality in this outcome area is good. All residents are looked after very well in respect of their health and personal care needs. Residents’ privacy and dignity is upheld and their life style choices respected. EVIDENCE: Care plans were seen in respect of the three residents who were case tracked. The owner is currently introducing a new method of care planning and it should be noted that this provides an excellent record of all care needs, detailed reviews and updating of risk assessments etc as required. Not all residents have such a plan of care yet, but it is the owners’ intention to provide all residents with such a document in the immediate future. The owners have put a lot of thought into the care plans, ensuring the records are such that they form a working, easily accessible and easy to understand working tool. The owner stated that the categories of residents within the home are currently split with sixty percent of current residents having mental health needs and forty percent having care needs arising from diagnosed dementia. Carl Court DS0000018334.V293319.R01.S.doc Version 5.2 Page 13 The residents’ health care needs were being fully met, including any specialist needs. All three residents had very specific individual needs and it was noted that these were both known and met. A resident’s next of kin confirmed this and the Commission received some very favourable feedback from other professionals prior to the inspection in relation to this. Such comments received include: “ I have undertaken planned and unplanned visits to Carl Court over the years and have always found the home well staffed and the residents well cared for. The home caters well for the varying needs of the resident, many of whom have mental health needs. Necessary reviews are always attended by one of the owners who provide excellent feedback”. “An excellent home who help people disabled by their mental illness to live as fulfilling a life as possible”. “I have worked closely with the owner and staff at Carl Court for about a year, specifically with one patient on continuing care. They are always communicative about changes and very supportive with plans which have to vary quite a lot on occasions. They are thoughtful and considerate and give detailed feedback and feel very much like colleagues in care. They are very open with my patient and treat her with great respect”. “One of the best residential homes in area”. “Excellent standard of care”. Medications were well managed, with each resident having full details of what medication is being prescribed not only on the mars sheet but also in the care plan. Accompanying this was the relevant patient information leaflet explaining about the medication, therefore easily available to staff. Staff who administer medication have attended local medication management training provided by the home’s supplying pharmacist. This was an in-depth days training session followed by the staff subsequently completing two modules in their own time which were sent away for assessment. This level of training has ensured that staff involved in medication administration are aware and trained appropriately and that residents are protected from the risk of inexperienced staff administering medication. The home uses a monitored dosage system, and the home’s medication records were inspected and seen to be in order. Controlled drugs were seen to be stored correctly and there were medication polices easily available for staff to follow. Medications are administered appropriately with all medications administered noted as signed for. Carl Court DS0000018334.V293319.R01.S.doc Version 5.2 Page 14 The owners have further instigated a daily audit of the medication procedure to ensure it remains fully in order. Other professionals are also involved with several of the residents and there are excellent relationships between visiting professionals, as can be evidenced from the previous comments contained within this report. All residents’ individuality and dignity was noted as being upheld with all residents presenting well, being well dressed, clean and ladies had nicely styled hair. Both the owners and staff were noted as treating residents with great respect and sensitivity and the atmosphere in the home was calm and pleasant, with residents clearly being relaxed and at ease. Carl Court DS0000018334.V293319.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 The quality in this outcome area is good. Residents were seen to enjoy a peaceful, pleasant yet varied life at the home, with visitors encouraged and various informal activities and trips out provided. Good meals are provided. EVIDENCE: The home operates an open visiting policy and the visitor’s book evidenced that the residents continue to have many visitors at varying times throughout the day. One visitor spoken with confirmed that she visited often throughout the week and was always made welcome. It was noted that the relative was able to speak openly and easily with the owners and was given up to date feedback as to their relatives condition. The relative confirmed that the owners work closely with other professionals to help enhance the resident’s quality of life, are always available within the home and are very supportive. They and the staff have helped support the resident and do all possible to help the resident undertake normal day to day activities like going out for a home visit. Carl Court DS0000018334.V293319.R01.S.doc Version 5.2 Page 16 The relative felt the resident had all the freedom she required but was provided with the care and support she currently needs to “keep on going”. Staff undertake activities with residents. On the day of inspection a manicure was taking place, which the female residents were clearly enjoying. There were records of all other activities provided and who had taken part, which allows the owners to monitor if any further activities should be made available or changes made. There is a weekly trip out in the home’s own people carrier, with the past two trips having been to Teignmouth and Dawlish. There is also external entertainment brought into the home on a regular basis such as Tranquil Moments (a session held involving music and singing), “Yesteryears”, and a visiting occupational therapy service, which provides gentle exercises. The owners are also liaising with the Local Authority to use a new service that the Authority is to introduce, which involves providing regular exercises for residents in care homes to aid general fitness. Residents were noted as being able to choose where they sat, some were in the main lounge, some were in the smaller lounge, one was reading in the garden, some were in their rooms. One went out with their relative and another was due to go out independently for a walk. All residents moved freely throughout the home unhindered. The home’s security and resident welfare is upheld by the home operating a keypad system on their external doors which, the owner informed, is linked to the fire panel, being disabled should the fire alarm ring and the exits be needed immediately. In normal daily use it provides a means to protect the more vulnerable resident, but those residents that are more mentally able and wish to be independent, as well as some visitors to the home, are given the correct code to be able to come and go freely from the home. Comments received at the inspection, from the residents, included such content as: “ I feel safe and well cared for here.” “I am free to come and go as I wish” “The staff are marvellous”. It was also noted that the correct day’s newspapers were provided within the home’s lounge. Residents continue to be encouraged to express their individuality as far as possible and to this end residents’ bedrooms are personalised as desired, in some instances in very specific manners. The home maintains a non smoking policy. Carl Court DS0000018334.V293319.R01.S.doc Version 5.2 Page 17 The home’s cook has been at the home since January and is very experienced with the needs of the elderly having previously owned and run her own home for twenty years. Menus were seen and it was noted that choice is always available. On the day of inspection the lunch was roast chicken with all the trimmings and fresh vegetables, followed by a trifle. It was noted that the residents had enjoyed the meal with many empty plates! There is also a choice provided at tea time and the home caters for any specific dietary needs which currently include providing for a Jewish resident’s dietary needs, as well as for a vegetarian diet. Any support required in helping with feeding is provided in a discreet manner and with due regard for other residents feelings. Currently three residents have their food liquidised and it was pleasing to note that each component of the meal is liquidised separately to make the meal still visually appealing. A staff comment received stated that in their opinion “one of the best things the home does is provide good food to the clients”. Overall, the routines within the home are very flexible to ensure that residents can choose how they spend their time. Carl Court DS0000018334.V293319.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 The quality in this outcome area is good. Arrangements for protecting residents and responding to their concerns are satisfactory. EVIDENCE: The home’s complaint procedure is contained within the home’s statement of purpose. During the inspection the owners also made a copy of this available within the home’s communal hallway. The home has not received any complaints since the last inspection carried out in November 2005. Since the last inspection the owners have instigated vulnerable adult training for staff, using both an external provider and training instigated by the Local Authority. Staff spoken to were aware of how to raise a complaint and what action would need to be taken in the event of any allegation of abuse being received. The residents spoken to, who were able to communicate, also stated that should they have any worries they would speak to the owner. Carl Court DS0000018334.V293319.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 The quality in this outcome area is poor. Although the home’s environment provides a clean comfortable, well maintained home for residents to live in, residents safety is being compromised by the owners not having yet protected all hot surfaces within the home, or having regulated the hot water to a safe temperature that services individual residents’ hand wash basins. EVIDENCE: The home remains comfortable, safe and well maintained with a very homely feel. The cleanliness of the home is a credit to the owners and staff as there a relatively high percentage of residents with continence problems and there was no unpleasant odour whatsoever throughout the home. The home’s cleaner was noted as ensuring that the home remained fresh and the owners have undertaken required upgrading work to ensure the home’s environment continues to be pleasant one to live in. One resident’s room has had cushion flooring fitted to help prevent odour and to ensure a pleasant bedroom for the resident. Carl Court DS0000018334.V293319.R01.S.doc Version 5.2 Page 20 The owner stated that this was undertaken with the agreement of the resident’s next of kin and has proved to be beneficial for all concerned. All other areas of the home were carpeted. Upgrading takes place as necessary and the owner pointed out areas, during the tour of the building that he was in the process of addressing. These included such things as re-decorating etc There is an attractive garden that is accessible and has been designed with safety in mind. The garden also contains an aviary and fishpond. The owners have fitted several magnetic door holders to fire doors that are required to be held open during the day. During the inspection it was noted that three doors (two residents and the door leading from the kitchen) were being wedged open. All other fire doors were noted as closed. The owner took immediate remedial action regarding the three fire doors wedged open by fitting a door guard to the kitchen door and ensuring the wedges were removed to the two residents’ doors. Although some radiators have low surface temperatures and two have been fitted with radiator covers, there still remains many that have not been protected and as such these pose a risk to residents sustaining a burn if fallen against. The home’s hot water supply has not been regulated to provide a safe temperature of approximately 43 degrees centigrade to residents’ individual wash hand basins. As such this also poses a risk to residents sustaining a scald from the hot water. The owner confirmed, however, that the water to the home’s communal baths had been regulated to a safe temperature of approximately 43 degrees centigrade. The home’s fire log was inspected. The owner was seen as keeping the required records of the weekly checks of the fire alarm system and of the home’s emergency lighting. However, at the inspection, the owner could not locate up to date records of any recent fire training given to staff, although the owner stated he could remember giving this training to staff. However due to the lack of these records it was not possible to verify this training had been given. Neither were there any records of any monthly visual checks of the home’s fire extinguishers. The home has a variety of aids and adaptations fitted throughout, such as grab rails, raised toilet seats, a hoist, and a hoist to one of the three baths. There is a ramp and access to the rear of the home. The home’s laundry room comprises of an external out building and was noted as being suitable for purpose. The home does not wash sheets, bedding etc, sending these to an outside contractor. It does however undertake all the personal laundry needs of the residents and there is a designated person responsible for laundry. The home provides anti bacterial hand wash within the home’s kitchen area and upholds routine measures to help prevent cross infection including having Carl Court DS0000018334.V293319.R01.S.doc Version 5.2 Page 21 clinical waste disposal, and staff being issued with gloves and aprons as needed etc. Planned infection control training is to be given, as part of the new training plan currently being made available for all staff. The home has not yet met the recommendation to obtain an assessment of the premises and facilities by a qualified person such as an occupational therapist. Carl Court DS0000018334.V293319.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 The quality in this outcome area is good. The home’s recruitment programme is now in order and protects residents by the appointment of suitable staff. Staff at the home are well trained and supported, and employed in sufficient numbers to meet the residents’ needs at all times. EVIDENCE: On the day of inspection there were fifteen residents in the home. Staffing levels were inspected and it was noted that there is sufficient staff on duty to care for the residents at all times and also that staff had sufficient time to spend with the residents in a relaxed social manner. All residents, that were verbally able to, confirmed that the staff care for them well and are available as required, as did the relative spoken to and feedback from other professionals stated the same. Updated and additional training has been put in place since the last inspection. This includes the use of an external training provider, as well as staff undertaking further NVQ training in care. Recent training provided by the external training agency has included first aid, food hygiene and health and safety. The external training provider is also working with the owners and staff to introduce an in-depth induction training course which takes several months to fully complete and includes topics such as food and hygiene, basic first aid, fire Carl Court DS0000018334.V293319.R01.S.doc Version 5.2 Page 23 awareness, risk assessment, diet and nutrition, dementia care, manual handling, infection control, coping with aggression, administration of medication, protection of vulnerable adults and general legislation. Staff spoken to felt this was useful training and some had already benefited from it. The staff undertake one section at a time and each is assessed by the external training provider. This has been newly introduced into the home, but is being received positively by the staff. A staff comment received back stated that one of the things they felt the home did really well was provide “continuous training to help me with my knowledge in care”. Additionally, any new staff also undertakes the home’s own basic induction training course. It was particularly pleasing to note that the first two weeks of any new staff member’s employment was spent shadowing other staff to gain familiarity with the very specific needs of the residents at the home. Out of the current six full time carers three are qualified to either NVQ level two or three in caring, therefore ensuring that fifty percent of the home’s staff are trained as required. Additional NVQ training is being provided including one staff member undertaking her NVQ level four in care having already achieved NVQ level three in care. This level of training ensures that staff are both appropriately trained and consequently able to provide suitable care for the residents at the home. Since the last inspection the home has experienced a high degree of staff changes, but it is to the owner’s credit that the current staff group are both experienced and form a good strong team. It is also to the owners’ credit that care staff are only expected to undertake care work, not being required to clean, do the laundry or cook (other than help with the residents’ teas). The owner stated that this is so the residents can receive the optimum care from designated care workers. When spoken to, the staff on duty felt that they performed well together and confirmed that they felt the residents got the best care available. It was evident that they took pride in their job and felt that ensuring residents had a good quality of life, irrespective of need or diversity, was the most important part of their role. All of the current care staff have experience in the caring industry. Three are from overseas, one having been at the home for two and a half years, but all have a good or reasonable understanding of the English language, which helps when caring for residents whose language skills and understanding may be poor due to mental frailty. Questionnaires received back from staff contained such comments as: “the home provides good food, high standard of care to clients provides activities for clients and that the owners are supportive towards the staff”. The staffing files for all newly appointed staff were inspected and it was noted that all the required information was available including a completed Carl Court DS0000018334.V293319.R01.S.doc Version 5.2 Page 24 application form, two references for each staff member and an enhanced CRB check. One of the owner’s sister lives and works in the home and the owners were informed that an enhanced CRB was also necessary for this relative. The owner was to instigate this immediately. The owners still need to provide formal supervision to staff and record the content of the supervision to allow for staff development and a designated time when staff can have an opportunity to discuss any aspect of their role that they need/want to. This can then be used to help enhance the staff members awareness and allow the owners an understanding of what additional support could be made available to individual staff members. Carl Court DS0000018334.V293319.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 The quality in this outcome area is adequate. The home is managed efficiently and well, with the owners being easily available and approachable and having an awareness of residents’ needs and the staffs’ abilities to meet them. The owners’ leadership ensures that the home is run in the best interests of the residents. The home provides a mostly safe, secure environment. EVIDENCE: The owner has completed her registered manager’s award and is waiting for verification of the award. The owners are continuing to improve the overall management of the home by ensuring all practices, policies and procedures, as well as the home’s records, are up to date and as required. Carl Court DS0000018334.V293319.R01.S.doc Version 5.2 Page 26 The owners are well respected by staff, residents, relatives and other professionals. Residents, who were able to, and staff spoke highly of their ability to help and support them. A feedback card from a relative stated that the owners: “are always around keeping a check on things”. They were confident because they felt the owners ran the home efficiently and in the best interests of the residents. One staff member stated: “the owners are very supportive to staff” and another: “I find Mr and Mrs Mungar caring and understanding owners. I am very impressed by the way the home is run”. The owners undertake quality auditing on an informal basis using such feed back as questionnaires, staff meetings ,review meetings etc. Previous discussion has already taken place in respect of the owners improving their quality auditing systems so that an accurate and workable record can be maintained. This would then inform the owners and staff generally and help the home build on its strengths and address any weaknesses that may present. The owners are very much aware of the need to respect diversity issues arising from caring for such a vulnerable group or residents. Due to the residents’ mental frailties, the owners and staff respect and work with differing behaviour issues ensuring all are treated with respect and equally valued. The residents’ families/advocates mostly deal with any financial matter appertaining to the residents with the home billing the appropriate relative accordingly for any expenses which they pay for initially. There were adequate records in respect of this, to protect the residents’ financial affairs. Residents’ health and safety is not being fully provided for due to previously identified shortfalls i.e. incomplete water relation, incomplete protection of hot surfaces within the home and the home’s fire records not being readily available. The owners use the services of an outside agency to undertake their risk assessments of the building and there was copy of the 2005 risk assessment for the building. There was also information in relation to the home’s water having been checked to ensure any risk appertaining to Legionella is minimised. The home’s accident book was noted as being in order with accidents reported correctly. The owners now forward details to the Commission of any incident, as required, under regulation 37, which affects a resident’s welfare. During the inspection the owner stated that all first floor windows had suitable restrictors in place, however it was noted that the window on the landing had Carl Court DS0000018334.V293319.R01.S.doc Version 5.2 Page 27 had the restrictor removed due to some redecoration. The owner immediately had the restrictor re-instated before the inspection ended. Carl Court DS0000018334.V293319.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 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 1 x x x x 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 4 x 2 x 3 x x 2 Carl Court DS0000018334.V293319.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 OP19 Regulation 23 (4) Requirement The owners must ensure that there is a record kept of the fire training provided for staff at the home and that this record is made available for inspection. The owners must ensure that all residnts’ hand basins within the home, are provided with hot water regulated to 43 degrees Centigrade to minimise the risk of residents sustaining a scald. Radiators must be guarded or have guaranteed low temperature surfaces. (previous timescale of 30/12/05 not yet met). All staff supervision must be documented. (previous timescale 30/112/05 not yet met) Timescale for action 08/09/06 2 OP19 13 (4) 08/02/07 3 OP19 13(4) 08/02/07 4 OP36 18(2) 08/11/06 Carl Court DS0000018334.V293319.R01.S.doc Version 5.2 Page 30 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP1 Good Practice Recommendations The owners should ensure that the home’s service user guide is updated regularly to ensure that the details contained within it are current i.e. the guide will need to be updated following the recent staff changes at the home. The owners should continue with the upgrading of residents’ care plans and ensure that the resident and/or their advocate is also involved in the drawing up of the plan and signs accordingly. The owners should obtain an enhanced CRB check for all persons working or living at the home, including any family member. The registered person should be able to demonstrate that an assessment of the premises and facilities has been made by suitably qualified persons, including a qualified occupational therapist. Continue as planned to develop the homes quality assurance system through questionnaires and surveys and any other received information that informs the owners as to how the home is operating and what may be improved upon. 2 OP7 3 3 OP29 OP22 4 OP33 Carl Court DS0000018334.V293319.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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