Inspection on 20/09/07 for Carrington House

This inspection was carried out on 20th September 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

Carrington House 08/11/06

Carrington House 14/02/06

Carrington House 26/07/05

Carrington House 02/03/05

Carrington House 09/08/04

Carrington House 01/03/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Carrington House Carrington Way Wincanton Somerset BA9 9BE Lead Inspector Sally Murphy Unannounced Inspection 20th September 2007 10:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Carrington House DS0000016102.V349120.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. Carrington House DS0000016102.V349120.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Carrington House Address Carrington Way Wincanton Somerset BA9 9BE 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) 01963 32150 01963 33590 karen.roberts@somersetcare.co.uk Somerset Care Limited Mrs Karen Roberts Care Home 44 Category(ies) of Old age, not falling within any other category registration, with number (44) of places Carrington House DS0000016102.V349120.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th November 2006 Brief Description of the Service: Carrington House is a detached property located in the centre of Wincanton. The home has been built on a hillside and is arranged over four floors. All areas of the home are accessible by passenger lift. There are a number of small lounges within the home and a large dining room. Service users are able to access a small garden at the rear of the property, and a roof terrace with seating provided. There are appropriate communal areas and bathing facilities to meet service users needs. The home is registered with the Commission for Social Care Inspection to provide personal care for up to 44 service users over the age of 65 years. The home does not provide nursing care. The Registered Provider is Somerset Care Limited. Fees at the home range from £373 – 475 each week, with additional charges made for newspapers, dry cleaning, toiletries and personal items. Carrington House DS0000016102.V349120.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection was completed by Sally Murphy and Jane Poole, Regulation Inspectors over one day. This was part of the planned programme of inspection. Prior to the inspection the Registered Manager provided CSCI with information regarding the service. As part of the inspection process Comment Cards (surveys) were sent to service users, relatives and health and social care professionals involved in their care. Information from these documents has been incorporated with this report. The previous inspection was unannounced, and was completed on 6th November 2006. There were 42 service users residing at the home. During the course of the visit a number of service users and staff members were spoken with. Care practice was also observed, records examined and a tour of the premises was made. The Inspector would like to thank the service users, staff and Manager for their time and assistance during this inspection. What the service does well: Service users provided spoke highly of the care provided. Prior to the inspection nine comment cards (surveys) were received from service users living at the home. Some of the comments received stated that staff are ‘always there if they want help’, ‘nothing is too much trouble for the staff and the care is excellent’, and you ‘can’t fault it’. The Registered Manager or Deputy Manager complete an assessment of need prior to any service user moving in, to ensure that the home will be able to fully meet their needs. Service users are encouraged to visit the home to assess the facilities provided. Those service users receiving intermediate care are helped to maximise their independence and return home. Care plans are maintained for each service user. These generally provided staff with sufficient guidance to meet service users needs. The home had taken appropriate action when one service user had lost weight. Service users are supported in accessing healthcare services. A range of trips has been provided including visits to Stourhead, Sherborne Castle and Longleat. The home ensures that each service user receives a card, cake and balloon on their birthday. Carrington House DS0000016102.V349120.R01.S.doc Version 5.2 Page 6 Menus at the home have been developed in accordance with nutritional guidelines for older people. A choice of meals is provided each day. Service users gave positive feedback on the meals provided. Service users live in comfortable rooms, with their own possessions. Appropriate equipment has been provided to meet service users’ needs. There is sufficient communal space and bathing facilities to meet service users’ needs. Staffing levels are appropriate, and flexible to meet service users’ needs. The hours worked by evening and morning staff overlap so that additional support may be provided to service users when they get up and go to bed. Staff are encouraged to undertake NVQ qualifications. Staff receive appropriate support and guidance to undertake their roles. Staff and service users stated that the Registered Manager is approachable. There is an open and relaxed atmosphere within the home. Appropriate records are maintained with regard to service users finances. Fire safety records and equipment servicing records have been appropriately maintained. What has improved since the last inspection? Staff have completed life histories for most service users. The Activities Coordinator has continued to develop the activities programme. Nutritional assessments have been completed and appropriate information provided to catering staff regarding service users dietary needs. A homely remedies assessment has been completed for each service user that has been signed by their GP. Clear records have been maintained of the administration of creams. Medication has been stored appropriately in accordance with manufactures guidance. The whistle blowing policy has been updated to include details of external agencies that may be contacted, such as CSCI. Since the last inspection, new plants and seating have been provided for the roof terrace and this is now an attractive area where service users may sit to enjoy views of the surrounding areas. The Registered Manager has ensured that two satisfactory references and a POVA First check have been completed prior to a member of staff commencing work at the home. Hazardous substances have been stored securely. Staff have received training on the use of hazardous substances. Carrington House DS0000016102.V349120.R01.S.doc Version 5.2 Page 7 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. Carrington House DS0000016102.V349120.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 Carrington House DS0000016102.V349120.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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides prospective service users and their families with appropriate information to make an informed decision regarding admission to the home. An assessment of need is completed prior to any service user moving in, to ensure that the home will be able to fully meet their needs. Service users are encouraged to visit the home to assess the facilities provided. Those service users receiving intermediate care are helped to maximise their independence and return home. EVIDENCE: Carrington House DS0000016102.V349120.R01.S.doc Version 5.2 Page 10 Somerset Care Limited has produced a Statement of Purpose and Service User Guide that provide details of the services and facilities offered at the home. Within the documentation sent to CSCI prior to the inspection, the Registered Manager advised that the Deputy Manager or themselves complete a comprehensive assessment of need prior to any service user moving in. The Registered Manager advised that the family of a prospective service user had recently contacted the home. Family members had visited the home. As the service user currently lives several hours’ drive away the Registered Manager had not been able to visit them. However the Registered Manager had obtained a copy of the assessment of need undertaken by Social Services and discussed this with the service users Social Worker. The Registered Manager advised that the prospective service user had been sent a copy of the Service User Guide to ensure that they had appropriate information regarding the home. Service users are admitted on a one-month trial basis. One service user spoken with stated that they had made the decision to move into the home permanently following a period of respite care. The home has one interim and one step-down bed. The service users accessing these services receive assistance from care staff in conjunction with visits from health and social care professionals such as an Occupational Therapist or Social Worker. The aim of these services is to provide service users with additional help during a period of ill health or to facilitate early discharge from hospital. Service users may receive this care for a maximum period of six weeks. On the day of the inspection one service user had returned to their home for a few hours. There was a planned programme in place for them to spend increasing amounts of time within their home before returning to live there within the next few weeks. These placements can sometimes be made on an emergency basis, and the Registered Manager seeks to ensure that appropriate information is provided prior to them moving in. Carrington House DS0000016102.V349120.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. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans generally contain sufficient detail to enable staff to meet service users’ needs. Some assessments had been updated in response to changes in service users health needs. Care plans have not been systemically reviewed to ensure that all existing plans remain appropriate. Service users receive appropriate support in accessing health care services. The management of medication is generally safe, however staff must take further action to ensure that a clear audit trail is maintained for all medication entering the home. Service users feel that they are treated with kindness and respect. Carrington House DS0000016102.V349120.R01.S.doc Version 5.2 Page 12 EVIDENCE: Care plans are maintained for each service user. Within the documentation sent to CSCI prior to the inspection, the Registered Manager advised that service users are consulted regarding their care plans, that life storybooks are completed for each service users and that plans are reviewed on a monthly basis. The home will shortly be moving to a system of computerised care plans. The Registered Manager confirmed that a paper copy would also be available should a service user wish to access or retain a copy of their records. During the course of the inspection, four care plans were examined in detail and a further two care plans reviewed to examine specific areas. Within the care plan for one service user it was evident that staff and responded promptly and appropriately when the service user had lost weight. A GP visit had been requested and catering staff were provided with updated guidance on the service users dietary needs. The service user had been weighed weekly as agreed with their GP and their Body Mass Index had been recorded. The nutritional risk assessment had been updated appropriately. Dietary monitoring forms had been completed, however it was not clear how these were being monitored or reviewed, or what actions were being taken as a result of these. The pressure risk (waterlow) assessment had been completed on 22/8/07 and further reviewed on 10/9/07. However on 10/9/07 it had not been completed in full. As this service user had experienced a significant weight loss it is important that the pressure risk assessment is regularly reviewed. The moving and handling assessment had been updated. Accident records had been maintained but the falls analysis had not been completed. There was no life history on file for this service user. The care plan was examined for a service user receiving respite care. The initial assessment within their file had not been signed or dated. The home had obtained a copy of their assessment of needs from Social Services. There was clear guidance for staff regarding the service uses dietary needs. Risk assessments had been completed in relation to the self-administration of medication and behavioural risk assessment. The risk assessment relating to the self-administration of medication had last been completed on 06/12/06. This must be regularly reviewed to ensure that it remains appropriate. The care records for this service user state that they have dementia, therefore their ability to safely manage their medication may have changed since this was completed. The falls risk assessment and moving and handling assessment updated appropriately. The care records for a further service user included appropriate plans to assist this service user who has sight loss. Records evidenced a gradual weight loss, and their Body Mass Index was now recorded as below 20. The pressure risk (waterlow) assessment had been updated on 12.3.07. Where a service user Carrington House DS0000016102.V349120.R01.S.doc Version 5.2 Page 13 has lost weight, the pressure risk assessment should be updated regularly so that appropriate measure, such as the provision of pressure relieving equipment may be taken to reduce this risk. A social history and life history had been completed. A record had been maintained of all professional visits. The care plan was examined for a service user who is diabetic. Records had been maintained of the service users blood sugar levels. The care plan included a risk assessment regarding the service user having a ‘hypo’, however the care plan did not contain information on symptoms that staff should be aware of, the normal blood sugar levels for that service user, or clear directions for staff to in the event of levels falling above or below those limits. There was evidence within the daily records that staff had responded appropriately when the service user had become hypoglycaemic. Clear guidance is required within the care plan to ensure that all staff will be able to provide this assistance in a consistent manner. A moving and handling assessment had been completed, and the service user had been weighed regularly. A life story had been completed with their key worker. Within the care plan for a further service user a number of risk assessments had been completed, but had not been reviewed since July 2002. The care plan for another service user evidenced that risk assessments had been completed in relation to the storage of denture cleaning tablets within the service users bedroom. Within all of the care plans seen, consultation with service users was based upon whether they were satisfied with the care provided. It was not evident that care plans had been systemically reviewed on a monthly basis, or that service users had been involved in the development or review of specific aspects of their plans of care. Service users spoken with during the inspection stated that staff were kind and that they were treated with respect. Within the comment cards (surveys) sent by CSCI one service user stated that ’All staff have been helpful, cheerful and kind at all times’. Service users confirmed that they always receive the care and support they need. The storage, recording and administration of medication were examined. Medications requiring refrigeration had been stored appropriately and the fridge temperature regularly monitored. Insulin had been stored correctly. Medication Administration Records were examined. A homely remedy sheet had been completed for each service user. Medication records included a photograph of the service user. Within the records for nine service users, staff had not maintained a record of the quantity or date when medication was received into the home. Some entries had only one signature recorded, but for the majority of hand transcribed entries there was no staff signature recorded. Variable doses had been recorded. There were clear directions for the administration of Warfarin tablets. The administration of creams had been Carrington House DS0000016102.V349120.R01.S.doc Version 5.2 Page 14 recorded within service users care plans. Appropriate records had been maintained for nutritional supplements. Carrington House DS0000016102.V349120.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are able to participate in a range of activities. Service users are encouraged to maintain links with the local community. Service users are encouraged to exercise choice over their lives. Meals are of a high standard and offer a well-balanced diet. EVIDENCE: Service users are able to participate in a range of activities, including games, puzzles, board games and manicures. An Activities Co-ordinator is employed. Staff also spend time with service users on a one-to-one basis. Service users confirmed that they had been on a number of trips, including visits to Stourhead, Sherborne Castle and Longleat. A hairdresser visits the home each week. Within the information sent to CSCI prior to the inspection, the Registered Manager stated that ‘We celebrate everyones birthday with a card, balloon and a cake’. On the day of inspection, the Cook was baking fresh cakes for forthcoming birthdays. Comment cards (surveys) were received Carrington House DS0000016102.V349120.R01.S.doc Version 5.2 Page 16 from nine service users. Eight of these stated that they are always satisfied, and one person that they are sometimes satisfied with the activities provided. Service users spoken with confirmed that they could get up and go to bed when they like. There were newspapers available within communal lounges. Service users are able to spend time within their rooms or communal areas, as they prefer. Information regarding the Age Concern Advocacy service and CSCI is displayed in the home. A church service regularly takes place at the home. Six comment cards were received from relatives of service users at the home, and each stated that they felt that their relatives’ needs were being met and that they received good communication from the home. Somerset Care Ltd has provided a set of menus that have been developed in accordance with nutritional guidance for older people. A vegetarian option is available each day. Service users spoken with during the inspection provided positive feedback on the meals provided, however one person stated that they were not always to ‘elderly peoples tastes’. Catering staff demonstrated a good understanding of people’s dietary needs and preferences. The Cook explained that they are trying to improve the range of desserts available to service users who are diabetic. During the course of the inspection, the Inspectors observed lunch being served. There was a relaxed and unhurried atmosphere within the dining room. A range of vegetables was available in serving dishes on each table and staff provided assistance as required. Carrington House DS0000016102.V349120.R01.S.doc Version 5.2 Page 17 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 has developed an appropriate complaints procedure, to ensure that service users are listened to. The home has appropriate policies relating to the Protection of Vulnerable Adults and Whistle blowing. EVIDENCE: The home has a complaints procedure entitled ‘seeking your views’, which is included in Service user Guide and is displayed within the home. There has been no complaints received by the home or CSCI since the last inspection. The home has a policy on the Protection of Vulnerable Adults. The Registered Manager was advised to obtain a copy of the updated guidance on Safeguarding Adults from Somerset County Council. Staff are made aware of the whistle blowing policy during their Induction training. Staff spoken with during the inspection were aware of the whistle blowing policy and stated that they would feel able to raise any concerns. Carrington House DS0000016102.V349120.R01.S.doc Version 5.2 Page 18 Since the last inspection the whistle blowing policy has been updated and now includes details of external agencies that staff may contact such as CSCI. Carrington House DS0000016102.V349120.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Generally, service users live in a safe and well-maintained environment. There is sufficient communal space and bathing facilities to meet service users’ needs. Service users live in comfortable rooms, with their own possessions. Appropriate equipment has been provided to meet service users’ needs. The home has been maintained to a high standard of cleanliness EVIDENCE: Carrington House DS0000016102.V349120.R01.S.doc Version 5.2 Page 20 Service user accommodation is provided over three floors. All parts of the home are accessible via the passenger lift. Some service user rooms have en suite facilities. There are sufficient assisted bathrooms within the home to meet service users’ needs. There are a number of small lounges on the ground and first floor, a large dining room and a smoking room on the first floor. There is an additional lounge / dining room on the top floor which opens on to roof terrace. Since the last inspection, new plants and seating have been provided and this is now an attractive area where service users may sit to enjoy views of the surrounding areas. Service users are encouraged to bring personal possessions such as photographs, pictures and small pieces of furniture with them to individualise their room. Service users are provided with a lockable space to store medication or valuables. There was a note on the window in room 16a that stated ‘do not open’, and hand basins within rooms 10 and 16a had cracks near the plughole and require replacement. There is a passenger lift, assisted bathrooms and a call bell system available. Handrails have been provided in corridors and chair raisers and raised toilets provided as required to meet service users needs. The temperature of hot water has been thermostatically controlled to prevent the risk of scalding. Radiators have been covered and window openings have been restricted on upper floors. The home has an Energy Representative who seeks to ensure that the home is energy efficient. The laundry was seen. There is a clear system in place for the management of laundry. The laundry was tidy and well organised. Alginate bags were available. Hand washing facilities consisting of liquid soap and paper towels had been provided for staff within communal bathrooms, toilets, en suite bathrooms and the laundry. In order to reduce the risk of cross infection it is recommended that foot operated flip top bins are provided. The home had been maintained to a high standard of cleanliness. Carrington House DS0000016102.V349120.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels are appropriate, and flexible to meet service users’ needs. Recruitment practices have improved since the last inspection. Staff have received the training required to undertake their roles. EVIDENCE: Duty rotas are maintained. There are generally a Supervisor, Shift Leader, and three Care staff on duty during the morning, and an additional carer from 7-10 am. During the afternoon there is a Supervisor, and three Care staff. At night there is a Supervisor, and one Care Assistant. The hours worked by evening and morning staff overlap so that additional support may be provided to service users when they get up and go to bed. Catering and Domestic staff are also employed. Staff spoken with during the inspection stated that staffing levels are adequate, although it can be difficult at night due to the layout of the building. Staff complete hourly checks on all service users, except where service users Carrington House DS0000016102.V349120.R01.S.doc Version 5.2 Page 22 have chosen for this not to occur. Staff spoken with were very clear about the procedures at night in the event of a fire. Within the information sent to CSCI prior to the inspection, the Registered Manager advised that Somerset Care Ltd provides a clear career structure for staff within their homes. They feel that this contributes to the high standard of care offered as all Supervisors and Shift Leaders will have all previously worked as carers and are able to demonstrate good practice. The Registered Manager also advised that there is flexibility in the rota to bring in extra care should it be required for a period of time. Comment Cards were received from eighteen staff members. All of which confirmed that they have received induction training, receive regular supervision, and that always a senior member of staff available to speak with. Staff confirmed that they have access to policies and are clear about service users needs. Staff are encouraged to study for NVQ qualifications in care. The Deputy Manager is an NVQ Assessor. Staff are provided with regular updates in mandatory training. All senior staff receive first aid training. The Registered Manager has advised that there are plans to provide care staff with training on palliative care, for the Activities Co-ordinator to receive further training, and for domestic staff to complete the NVQ level 2 qualification in cleaning and support services. Three staff recruitment files were examined during this inspection. Two satisfactory references and a POVA First check had been completed prior to each staff member commencing employment at the home. The employment history for one staff member only provided details of employment from August 2006 onwards. It is recommended that a full employment history is obtained so that any gaps in employment can be discussed. Staff had received Induction training, regular supervision and a review following six weeks employment. Carrington House DS0000016102.V349120.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): 31,32,33,34,35,36,37 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed. There is an appropriate structure of senior staff in place. There are systems in place to seek the views of service users, visitors and staff. Service users’ financial interests are safeguarded. Generally, the Registered Manager has taken appropriate actions to promote the health and safety of staff and service users at the home. Carrington House DS0000016102.V349120.R01.S.doc Version 5.2 Page 24 EVIDENCE: The Registered Manager is Mrs Karen Roberts. She has many years of experience providing care to older people and has completed the Registered Managers Award. Staff and service users stated that she was approachable and that they would be able to raise any issues of concern. Staff spoken with during the inspection stated that they felt supported by the management team. There was a relaxed and open atmosphere within the home. Service users are able to express their views at service user meetings, family meetings and care reviews. There is also a suggestion box available. Staff meetings are held every three months. The Registered Provider undertakes visit each month in accordance with Regulation 26 of the Care Home Regulations 2001. These visits include discussions with staff members and a review of the environment. Regulations 26 visits must also include discussions with service users to seek their views regarding the standards of care provided at the home. The home will keep money securely for any service users that wish them to. A record is maintained of all transactions, which are supported by receipts and a staff signature. Monies are held separately for each service user. Monies were checked for three service users, and each was found to tally with the records maintained. The home displays appropriate employers liability insurance. Kitchen records had been appropriately maintained. The report from Environmental Health Officer stated that ‘it appears to be a very well run kitchen’. Fire safety records and equipment servicing records had been appropriately maintained. Hazardous substances had been stored securely. Staff confirmed that they had received COSHH training. The oxygen cylinder stored within a service users bedroom had not been secured. This may pose a risk of injury from the cylinder falling on somebody or from the cylinder head becoming damaged if the cylinder is knocked over, and therefore must be secured. Accidents had been recorded and reported as required. Carrington House DS0000016102.V349120.R01.S.doc Version 5.2 Page 25 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 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 2 3 3 3 3 2 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 3 3 3 3 2 Carrington House DS0000016102.V349120.R01.S.doc Version 5.2 Page 26 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 OP7 Regulation 15 (1) Requirement The registered person shall prepare a written plan outlining how staff will meet service users health and welfare needs. This is with regard to: - a comprehensive diabetic care plans being developed for those service users who have diabetes. - social histories being completed for each service user. (Previous timescale of 15/12/06 not met). - risk assessments must be regularly reviewed to ensure that they remain appropriate. 2. OP8 15 (2) a The registered person shall keep the service users plan under review. This is with regard to: - pressure risk assessments being reviewed regularly, and at greater frequency when there is Carrington House DS0000016102.V349120.R01.S.doc Version 5.2 Page 27 Timescale for action 30/11/07 30/11/07 an identified high level of risk. - care plans being reviewed regularly to ensure that all appropriate sections within the care plan is updated to reflect a change in their needs. (Previous timescale of 15/12/06 not met). - Where dietary monitoring forms are completed, these must be regularly reviewed and any necessary actions taken. - falls should be analysed to ensure that appropriate steps may be taken to reduce the level of risk. 3. OP9 13 (2) An appropriate record must be maintained for all medication entering the home. The record must include the quantity of medication, date and staff signature. Risk assessments relating to the self-administration of medication must be regularly reviewed. 4. OP19 23 (2) [p] Appropriate actions must be taken to fix the window in room 16a. 31/10/07 12/10/07 5. OP21 23 (2) [j] The home must ensure that hand 31/10/07 basins that are worn or cracked are replaced within the refurbishment programme for the home. The person carrying out Regulation 26 visits shall with their consent, and in private interview service users in order to form an opinion of the standard of care provided. DS0000016102.V349120.R01.S.doc 6. OP33 26 (4) [a] 31/10/07 Carrington House Version 5.2 Page 28 7. OP38 13 (4) [c] The oxygen cylinder stored within a service users bedroom must be secured so that it cannot fall over. 12/10/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations It is recommended that hand transcribed entries on medication administration records are checked and signed by a second staff member, to reduce the risk of error. In order to reduce the risk of cross infection it is recommended that foot operated flip top bins are provided. It is recommended that a full employment history is obtained so that any gaps in employment can be discussed. 2. OP26 3. OP29 Carrington House DS0000016102.V349120.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Taunton Local Office Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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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