Inspection on 22/11/06 for Cecil Court

This inspection was carried out on 22nd November 2006.

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

Cecil Court 23/05/07

Cecil Court 07/06/06

Cecil Court 29/11/05

Cecil Court 15/06/05

Cecil Court 16/12/04

Cecil Court 01/07/04

Cecil Court 19/02/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Cecil Court 2-4 Priory Road Kew Richmond Surrey TW9 3DG Lead Inspector Sandy Patrick Unannounced Inspection 22nd November 2006 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 Cecil Court DS0000017354.V319264.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. Cecil Court DS0000017354.V319264.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cecil Court Address 2-4 Priory Road Kew Richmond Surrey TW9 3DG 020 8940 5242 020 8332 1044 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) Central & Cecil Housing Trust Miriam Kajencki Care Home 45 Category(ies) of Old age, not falling within any other category registration, with number (45), Physical disability over 65 years of age of places (45) Cecil Court DS0000017354.V319264.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection Brief Description of the Service: Cecil Court is a residential care home for up to forty-five older people. The home is managed by Central & Cecil Housing Trust. The Trust is a non-profit making organisation providing accommodation and support to vulnerable adults throughout London and the Home Counties. The house is situated in pleasant grounds in Kew, close to local shops, public transport links and local facilities. The home is also close to Kew Gardens and the River Thames. Accommodation is provided on three floors, all accessed by a passenger lift. The home is divided into four units, accommodating between 6 - 19 people. Each unit is equipped with its own facilities and communal space. All bedrooms have en suite facilities. The Registered Persons have produced a Service User Guide, which includes information on the aims and objectives of the service. The fee range is £550 - £600 per week. Cecil Court DS0000017354.V319264.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place on the 22nd November 2006. Two Regulation Inspectors visited the home. They met with the people who live there, staff on duty and the Manager. The Inspectors also looked at records and the environment. The Inspectors were made welcome by everyone. The people living and working at the home spoke positively about their experiences. At the last inspection visit some staff expressed concerns about the way they were supported to do their jobs. During this visit, many of the staff said that they felt things had improved over the last six months. The people who live there said that they liked the food and that the staff treated them well. The staff said that they felt good systems had been introduced and that they were supported in their roles. The environment is generally improvements to some areas. well maintained and there have been Shortly after the last inspection some staff, relatives and other visitors contacted that CSCI with a variety of concerns. The CSCI met with Senior Managers within the organisation. They discussed some of these as part of that meeting. Those wishing to make a complaint were referred to the organisation’s complaints procedure and advised to contact senior managers. There were no written surveys used as part of this inspection. Surveys were sent to all the people who live and work at the home, visitors and other professionals as part of the last key inspection in June 2006. The findings of these are recorded within the last inspection report. What the service does well: What has improved since the last inspection? Cecil Court DS0000017354.V319264.R01.S.doc Version 5.2 Page 6 The general atmosphere has improved and people said that they were happier living and working at Cecil Court. There has been improvements to activities and some special events have been organised. New furniture has been purchased. The Manager said that they are going to start a monthly newsletter. There have been improvements to the way medication is managed and senior staff make regular checks so that improvements continue. There has been improvements to staff communication and morale. The staff said that they feel that they are consulted and more involved in decision making. There have been improvements to record keeping. What they could do better: Some people who have moved to the home have needs which fall outside of the registration categories. The Manager needs to make sure the staff have the training and skills to support these people. The Manager must make sure the home is registered to meet these needs. The assessments for new people need to include information from different sources and information on risks. These must be available for staff to help them to get to know individuals. There needs to be improvements to care plans. There needs to be a more person centred approach to meet individual needs, wishes and aspirations. The people who live at the home need to be involved in the development and review of their care plans. There needs to be a well organised keyworking system, where each individual has a member of staff assigned to them to help them to look at how all their needs are being met. Some people organise their own time and this is good. However, there needs to be more support so that everyone can pursue individual interests and hobbies. The staff need to make sure everyone gets a meal (including drinks) of their choice and that they are offered alternatives if they do not like the food that they have been given. Cecil Court DS0000017354.V319264.R01.S.doc Version 5.2 Page 7 People who live at the home should be more involved in the recruitment of staff, development of procedures and looking at how the service can improve. The staffing levels need to be reviewed to make sure individual needs are met. 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. Cecil Court DS0000017354.V319264.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 Cecil Court DS0000017354.V319264.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): 3&4 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some people living at the home have needs that the home is not registered to meet. Some assessments do not include all the information about new people. Staff do not always have access to the assessments for new people. EVIDENCE: Three people living at the home have mental health needs. The home is not registered to meet the needs of these people. The Manager must apply to vary the categories of registration. In order to do this the Manager must make sure the staff have the skills, training and knowledge to meet the needs of these people and to keep them safe. Cecil Court DS0000017354.V319264.R01.S.doc Version 5.2 Page 10 People who spoke to the Inspectors said that they had visited the home before they made a decision to live there. They said that the home suited their needs and that they were happy there. The Manager or senior staff carry out assessments on people interested in moving to Cecil Court. The CSCI was contacted by a local authority social worker who arranges the funding for one person. They said that the staff working with this person had not been made aware of information that they had given as part of their assessment. They also said that in the first few weeks of this person living at the home there was no care plan and the staff did not have access to the assessment. It is important that assessments made by senior staff include information from a range of different sources. The assessment should be available for staff working with that person until a care plan has been developed. Cecil Court DS0000017354.V319264.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. Each person has a care plan but these need to be improved. People need to be more involved in the development and review of their own care plan. Care plans need to give more detail on individual needs including social and cultural needs, wishes and aspirations. The language used and the layout of care plans needs to be improved. Health care needs are generally well met but some needs are not recorded in care plans. There are not always enough staff on duty to help people with all their personal care needs. EVIDENCE: There is a care plan for everyone at the home. Some people have signed copies of their care plans and could tell the Inspectors the sort of information Cecil Court DS0000017354.V319264.R01.S.doc Version 5.2 Page 12 written in their plans. However, others were not aware of what was written about them. The language, layout and information in care plans is not accessible to the people they are written about. A new computerised system of care planning is being introduced at the home. There have been improvements to the organisation of some care plans. Each care plan is now held in its own folder. However some care plans were not well organised and information was confusing and muddled. Some information was repeated. The layout of some care plans was confusing as needs were recorded alphabetically rather than in an order which made sense to the person they were about. For example in several care plans ‘dying and death’ was recorded next to ‘domestic skills’. The staff should give more consideration to writing a care plan which is clear and more easily accessible. Care plans were very task orientated and focused on personal care and health needs. The majority of care plans which the Inspectors looked at did not include information on social and leisure needs, or the information was very basic. Sometimes the information was inappropriate. In one person’s care plans the likes in the social needs section stated, ‘likes most sweet things’. When information about someone’s likes and hobbies had been recorded there was no evidence to show that staff helped this person to pursue this interest. There needs to be an effective keyworking system where individuals are allocated a member of staff who takes time to find out about their interests, needs, wishes and aspirations. These need to be recorded in detail. The staff who work with each person need to spend time making sure these needs are met regularly. There needs to be a far more person centred approach to care planning and day-to-day support. The people who live at the home need to feel that they are the central part of this and that they have planned their own care, not that it has been organised for them. The staff need to focus on individual needs in every aspect of someone’s care. The Manager said that person centred planning training has been organised for staff and that they are starting to have a better understanding of this. This needs to be put into practice. The Manager spoke about the specific health care needs and risks for some individuals. The care plans for these people did not contain detailed information about these needs. There was poor spelling, punctuation and inaccuracies in some care plans. In some cases this changed the meaning of the care plan. In one case the contact details for one person’s next of kin had been wrongly recorded. Some of the terminology in care plans was inappropriate and focused on negatives and things that the person could not do rather than their skills. For example one care plan started by stating, ‘even though (person) has dementia…’. Another care plan stated that the person was ‘usually helpful Cecil Court DS0000017354.V319264.R01.S.doc Version 5.2 Page 13 when getting dressed’. The staff should remember that they are the ones helping and not the person who they are writing about. One care plan referred to ‘the resident’ rather than the name of the person. One care plan asked the question ‘does (person) have any trouble sleeping?’ however there was no answer to this or recorded information about this. A lot of the information within care plans was recorded in tick boxes rather than statements about individual needs. Some care plans contained conflicting information. For example, in one section of a care plan it stated that the person wore dentures and needed a soft diet. In another section it stated that the person had a normal diet. The information on religious and cultural needs was very basic and was usually only a statement about their chosen religion not about how they met these needs. One care plan identified serious mental health needs, however there was no information on how to support the person with these. Care plans are regularly reviewed and this is recorded. evidence of regular keyworker input into the care plans. However there is no Risk assessments were very basic and generally only in place regarding moving and manual handling. Risk assessments included scores and basic words like, ‘stick’, ‘two staff’ and not practical information to tell the reader what support is needed and given. There was no care plan in place for a person known to have left the building unattended and to be at risk from this. A file of information for new and temporary staff has been developed for each unit. This is a good guide of basic quick reference information. However individual allergies were not recorded within this and must be. Everyone is registered with local GPs and other health care professionals as needed. The staff said that they feel supported by health care professionals and have worked closely with them to meet individual needs. New digital scales which help assess body mass index have been purchased. The Manager said that the staff are working with dieticians to risk assess individual nutritional needs. There is an appropriate medication procedure and the Inspectors saw the staff following this when administering medication. Regular audits are made and recorded. Information on different medicines, their uses and side effects was available for staff. Medication was labelled correctly and the date of opening on topical lotions was recorded. Laminated sheets with each individual’s name, photograph and allergies were held with medication records. There was Cecil Court DS0000017354.V319264.R01.S.doc Version 5.2 Page 14 a list of staff signatures and abbreviations. Medication was stored appropriately. New medication trolleys had been purchased for one unit and the staff said that these were an improvement. The majority of records were accurate. In a small number of cases there were not always records of why PRN (as required) medication was administered. The people who spoke to the Inspectors said that they felt that they were well cared for and that their personal needs were met. One person said that the night staff were very caring and always came quickly when they pressed the call bell at for assistance. They said that they were very kind and attentive. In one unit where eight people live, there is only one member of staff on duty in the mornings. The staff told the Inspectors that it was difficult to help get everyone up and that they did not have time to offer people baths if they wanted one. They said that people could only usually have one bath a week as there was not enough staff to offer them more if they needed assistance. Some people who live at the home said that this was a problem at the last inspection. Cecil Court DS0000017354.V319264.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 good. This judgement has been made using available evidence including a visit to this service. There is a good range of organised group activities and these have improved. There needs to be some more work to make sure individual needs are met. People living at the home have information about changes and day-to-day life. This is improving and there will soon be a regular newsletter. The people living at the home could be more involved in making decisions that effect them as individuals and as a group. There is a choice of varied and wholesome food. The staff need to make sure that everyone is supported to make informed choices. The staff need to make sure everyone has enough to eat if they do not like the meal which they have. EVIDENCE: There is a planned programme of group activities. These are well advertised and the Inspectors witnessed the staff reminding people about the planned activity on the day of the inspection. Cecil Court DS0000017354.V319264.R01.S.doc Version 5.2 Page 16 The staff and some of the people who live at the home said that the planned activities had improved. There are some new regular activities, including cake making which people have really enjoyed. There have also been new themed events for special occasions, like Halloween, Bonfire Night and American Thanks Giving. The chef has created special menus and there have been decorations and activities based on the event. Preparations for Christmas events were taking place at the time of the inspection. A group of people living at the home have formed a choir and they gave a special performance at a local centre. Some people are fairly independent and go out alone. They told the Inspectors that they enjoyed this freedom. The staff said that they had had more opportunities to take other people out over recent months to local shops, cafes and pubs. Some people attend local places of worship. Church of England and Catholic services are held at the home regularly and anyone is free to join these if they wish. On the day of the inspection staff were offering nail care. The staff doing this said that they had been trained in this area. The improvements in planned activities have been positive. However, further work to look at individual needs must take place. One person who is deaf told the Inspector that they could not participate in the activities because of their disability. Another person indicated that they liked particular films and sport in their care plan. However, there was no evidence that they were supported to enjoy these. The staff were very kind and caring but did not spend time sitting talking to individuals or helping them to pursue their interests. The group activities should continue but the staff need to also focus on individuals. The Manager said that she is going to introduce a non profit making trolley shop where people who do not regularly go out to the shops can get basic goods, confectionary, and toiletries. The home welcomes visitors at any time and families and friends continue to be involved in care if they wish. There are regular relative meetings. Telephones are available throughout the home and people can have their own telephone line installed in their room if they wish. The Inspectors witnessed a member of staff offering to support someone to telephone their family. The people who live on each unit are invited to regular meetings where they discuss plans for the home and activities. The Manager said that staff are going to make a monthly newsletter which will help keep everyone informed. Cecil Court DS0000017354.V319264.R01.S.doc Version 5.2 Page 17 Notice boards within the units display activities and the menu for each day. The Manager said that she is hoping to improve the way in which the menu is presented. Leaflets, the Statement of Purpose, Service User Guide and other information about the home and organisation are available near the main entrance. Copies of the complaints procedure are displayed around the home. The people who live at the home need to be more involved in making their care plans. The Manager should also think about ways in which they can be involved in the recruitment of staff, developing policies and procedures and quality monitoring. Throughout the day the staff treated everyone with respect and kindness. Some of the things that people who live at the home said were, ‘I can have visitors whenever I want’, ‘I go out and about as I please’, ‘I feed the birds and enjoy watching them’, ‘there is a nice warm atmosphere’, ‘there is always something going on’ and ‘the food is really nice’. The menu is varied and offers a choice at each meal. There are small kitchens on each unit and these are stocked with basic food. One person said that they could have sandwiches or toast at anytime if they were hungry. The staff ask for feedback on meals which they discuss with the cook. The Inspectors observed lunch in two different units. In one unit someone was given a meal which they said that had not ordered. The staff member left this in front of them and did not offer them an alternative. In the other unit there had been some confusion about the meal and two people had ordered something which turned out to be a different dish to the one they were expecting. The staff who offer the menu choices and give these to the cook should make sure they understand exactly what the dish is so that they can give accurate information when people are making the choice. On this occasion the people were not offered an alternative at lunch time and even though neither of them ate their meal, they were not offered anything else to eat. The staff member then gave choices for pudding which they went to collect from the kitchen. They returned saying that one of the choices was not available and therefore they brought everyone the same pudding. This was discussed with the Manager who agreed that people should have been offered alternatives and that there should have been enough different desserts for everyone to have the one that they chose. Tables were nicely laid for lunch and the staff offered a choice of tea and coffee after meals. However, there was no choice of drink during the meal and everyone was given the same flavour squash. Cecil Court DS0000017354.V319264.R01.S.doc Version 5.2 Page 18 All meals were served by the staff on duty and people were not given a choice of portion sizes. The Manager said that she is planning to introduce vegetable dishes at the dining tables so that people can help themselves to the quantity that they want. Cecil Court DS0000017354.V319264.R01.S.doc Version 5.2 Page 19 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. There is an appropriate procedure regarding complaints. There are procedures regarding the protection of vulnerable adults. The Manager needs to make sure that all staff are familiar with the local authority procedure. EVIDENCE: There is a suitable complaints procedure and copies of this are available throughout the home. People said that they knew who to speak to if they were unhappy about anything. All complaints are recorded. The records of these have improved since the last inspection. However, the records should have clearer information on the outcomes of any complaint made. The organisation have their own procedures on the Protection of Vulnerable Adults. The Manager said that she was not familiar with the London Borough of Richmond procedure. The Manager must make sure there are copies of this procedure at the home and that she and all staff are familiar with it. Staff have had some training in abuse awareness. The Manager must make sure all staff are trained in this area. Cecil Court DS0000017354.V319264.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, 20, 21, 23, 24 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a safe, well maintained, clean and pleasant environment. EVIDENCE: The building is situated in pleasant and well-kept grounds, with level access areas and raised beds. The home is generally well decorated and maintained. Pictures, plants and ornaments were seen throughout communal areas. The home is divided into four interconnecting units each with a lounge, kitchen, bathroom and laundry facilities. Everybody has their own room with en suite facilities. They are able to bring furniture and belongings to personalise their rooms. Cecil Court DS0000017354.V319264.R01.S.doc Version 5.2 Page 21 Over the last year there has been continuous improvement to the environment. Some dining and lounge furniture and two carpets have been replaced since the last inspection. Units have been equipped with new kitchen cupboards and work surfaces. The layout of some communal areas has changed and people said that this was better. Everyone who spoke to the Inspectors said that they liked the environment. Many said that they liked their rooms and that they felt the home was clean and well maintained. In general the home was very clean on the day of the inspection. The fish tank in one unit was dirty and the water level low. The staff should make sure the tanks are appropriately maintained. Cecil Court DS0000017354.V319264.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. 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. There have been positive changes to the way in which staff work, allocations of staff and communication within the team. The staff feel that they have access to good training and are supported and listened to. There needs to be a review of staffing levels to make sure the needs of individuals can be met. EVIDENCE: Since the last inspection the way in which the home has been staffed has changed. The Manager and the staff who spoke to the Inspectors said that this was an improvement. A new rota has been introduced which allows for a handover between shifts for all staff. Staff on duty said that they liked the new rota and felt that it worked well. Changes have been made to when the staff take their breaks and they also said this had improved the running of the home. Some of the things that need to improve cannot be achieved within current staffing levels. For people to have the support they need to have regular baths Cecil Court DS0000017354.V319264.R01.S.doc Version 5.2 Page 23 when they want there needs to be an increase of staff in at least one unit. For keyworkers to spend time working with individuals to meet their needs and look at a person centred approach to care the general staffing levels need to improve. Throughout the inspection staff were seen attending to tasks and did not spend time sitting with people chatting and supporting them with individual interests. A volunteer is employed to help with this but more staffing is needed to make sure individual needs are met. Staffing levels should be reviewed giving consideration to these areas. Since the last inspection three senior staff, including the Deputy Manager, have left the home. Staff have been temporarily promoted to cover these positions and the permanent posts have been advertised. The Manager went on holiday shortly before the inspection. She said that the house was well run in her absence. The Manager said that other staff vacancies had been recruited to and that checks were being made on the successful candidates. The staff who spoke to the Inspectors said that they had information about their roles. They demonstrated a good knowledge of the people they were working with. The staff on duty said that they felt that the atmosphere at the home had improved since the last inspection. They said that they worked better as a team and that they were given more information and consulted about changes. Staff said that they had access to a wide range of training and that this was well organised and useful. Some members of staff were due to commence a five day course on dementia care. They should share the information that they learn with others. The Manager should organise for as many staff as possible to have this training. The Manager said that she is updating training profiles for all staff. She said that she is hoping to arrange for senior staff to have the training to enable them to conduct in house training for others. There is an intensive induction for all new staff linked to NVQ training. The induction includes a work book about basic care, external training in key areas and shadowing experienced staff. Staff, including kitchen and domestic staff, are supported to undertake NVQ qualifications. There is a suitable recruitment and selection procedure. The Manager and senior staff interview potential staff, there is a written test, reference and criminal record checks are made. The Manager showed evidence of thorough recruitment checks on the new staff. She said that she is going through staff Cecil Court DS0000017354.V319264.R01.S.doc Version 5.2 Page 24 files for all existing staff to make sure the required information is in place. The Manager should look at ways of involving the people who live at the home in recruiting new staff. There are regular staff team and individual supervision meetings for all staff and these are recorded. Cecil Court DS0000017354.V319264.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, 32, 33, 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 service is appropriately managed and people feel happier with the way that they are supported and involved. There are systems for quality monitoring, although there is potential for more work in this area and involving the people who live at the home more. There are regular checks on health and safety. Some minor health and safety issues need to be attended to. Cecil Court DS0000017354.V319264.R01.S.doc Version 5.2 Page 26 EVIDENCE: The Manager has been employed since January 2006. She has a range of experience in different caring and management roles. She is qualified to NVQ Level 4. Since the last inspection the people who live and work at the home feel more supported and listened to. At the last inspection a lot of people were concerned about changes, morale and management approach. However, things seem to have really improved at this inspection and everyone who spoke to the Inspectors said that there had been some positive changes. They said that they felt able to contribute their opinions and that some things were better organised. The staff said that they felt supported by the team and senior staff. The organisation arranges for monthly quality inspections of the home. Copies of these visits are not always sent to the CSCI regularly and the records should be sent once they are completed. These quality inspections look at admissions, discharges, complaints, staffing changes, activities, falls and incidents. The staff have started to take feedback after mealtimes and give this information to the cook. The Manager should consider ways to involve the people who live at the home and the staff in more quality monitoring of the service. The home has improved at informing the CSCI when people have an accident or a fall. The staff reported that they have regular supervision and team meetings. People who live at the home make private arrangements for the management of their finances. Small amounts of cash are held by the home so that service users can make small purchases and pay for additional services, such as hairdressing. There have been improvements to record keeping. Records are better organised and information more accessible. Computers have been installed on some units and the Manager hopes that more computers will be made available for staff. All staff are receiving training in the new computerised care planning system. There are regular checks on health and safety, including fire safety, and the environment. These are recorded. Cecil Court DS0000017354.V319264.R01.S.doc Version 5.2 Page 27 The records of fridge temperatures in one unit indicated that the fridge was regularly too cold (up to -4°C on one occasion). Action should be taken to make sure that fridges and freezers are maintained at appropriate temperatures. A first aid supply in one unit did not contain the correct items. Some sterile bandages had expired and some packages were torn. The Manager must make sure first aid supplies are complete, within date and checked on a regular basis. Cecil Court DS0000017354.V319264.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 2 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 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 2 3 3 3 X 3 3 X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 3 2 Cecil Court DS0000017354.V319264.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 OP4 Regulation 12 14 Requirement Timescale for action The Registered Person must not 31/01/07 admit anyone who has needs that the home is not registered for. They must make an application to vary the registration where necessary. The Registered Person must 31/01/07 make sure the staff have the training, skills and knowledge to support the people living at the home. Previous 31/08/06 requirement 2. OP4 12 18 3. OP3 12 14 The Registered Person must 31/01/07 make sure assessments include information from a range of different sources. The assessment must be available for staff working with that person until a care plan has been developed. Cecil Court DS0000017354.V319264.R01.S.doc Version 5.2 Page 30 4. OP7 12 15 The Registered Person must make sure: Care plans are clear and can be easily understood. Terminology appropriate. Information accurate. in in care care plans plans is is 31/01/07 Information on allergies is recorded within all care documents. Previous 31/08/06 5. OP8 12 13 requirement The Registered Person must 31/01/07 make sure health care conditions are appropriately recorded and care plans in place to meet any health care needs. Previous 31/08/06 requirement 6. OP12 OP7 12 16(2)(m) The Registered Person must 31/03/07 make sure social interests, wishes, likes and aspirations are recorded within care plans and that action is taken to meet these individual needs and wishes. Activities must be organised to meet the needs of all residents and they must not be discriminated against because of disability. Activities must be organised to meet the needs of all residents and they must not be discriminated against because of Cecil Court DS0000017354.V319264.R01.S.doc Version 5.2 Page 31 disability. Previous 31/10/06 7. OP7 12 13(4) requirement The Registered Person must 31/01/07 make sure risk assessments are in place wherever there is a risk and that these are detailed and consider how residents can be enabled to make informed choices and to take risks. The Registered Person must 31/01/07 make sure details of why PRN medication is administered are recorded. The Registered Person must 31/01/07 make sure residents are able to take a bath or shower as often as they like and staffing allows for residents to have regular baths at a time of their choosing. Previous 31/07/06 requirement 8. OP9 13(2) 9. OP10 12 10. OP15 12 16(2)(i) The Registered make sure: Person must 31/01/07 Staff have accurate information to support residents to make an informed choice about meals. Residents are given a choice of drinks with meals. Residents are offered alternatives at mealtimes if they do not like the food they have been given. Cecil Court DS0000017354.V319264.R01.S.doc Version 5.2 Page 32 There is enough food so that everyone can have the meal and dessert they have chosen. 11. OP18 13(6) 18 The Registered Person must 31/03/07 make sure the Manager and staff are familiar with the local authority Protection of Vulnerable Adults procedure and that copies of this are available at the home. All staff must have been trained in the protection of vulnerable adults and have a good understanding of this and their responsibilities under the whistle blowing procedure. 12. OP27 18(1)(a) Staffing levels must be reviewed 31/03/07 to make sure the assessed needs of all residents can be fully met. The Registered Person must 31/01/07 make sure fridge temperatures are maintained at a safe level. The Registered Person must 31/01/07 make sure first aid supplies are well maintained. 13. OP38 13(4) 14. OP38 13 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Cecil Court DS0000017354.V319264.R01.S.doc Version 5.2 Page 33 1. OP14 The Registered Person should make sure staff follow a more person centred approach where the resident is central to the development of their own care plans and where individual needs are met. There should be an effective keyworking system where staff spend time listening to and meeting individual needs. 2. OP15 Residents should be able to help themselves to vegetables at the dining table and should be offered a choice of portion sizes. Complaint records should have clearer information on the outcomes of any complaint made. Fish tanks maintained. should be appropriately cleaned and 3. OP16 4. OP26 5. OP33 The Manager should make sure Copies of Regulation 26 visits are sent to the CSCI in a timely manner. The Manager should consider ways to involve the residents more in the recruitment and selection of staff, development of procedures and quality monitoring. 6. OP33 Cecil Court DS0000017354.V319264.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection SW London Area Office Ground Floor 41-47 Hartfield Road Wimbledon London SW19 3RG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Cecil Court DS0000017354.V319264.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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