Inspection on 23/05/07 for Cecil Court

This inspection was carried out on 23rd May 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

Cecil Court 22/11/06

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 4 Priory Road Kew Richmond Surrey TW9 3DG Lead Inspector Sandy Patrick Unannounced Inspection 23rd May 2007 10:00 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.V341037.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.V341037.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cecil Court Address 4 Priory Road Kew Richmond Surrey TW9 3DG 020 8940 5242 020 8332 1044 miriam.kajencki@ccht.org.uk 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.V341037.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11 November 2006 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. A place at the home costs between £580 - £630 per week. Cecil Court DS0000017354.V341037.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the Inspector found during the inspection. The inspection included two visits to the service on the 23rd and the 24th May 2007. A Regulation Inspector visited the home and met with some of the people who live there, staff, the Manager and some visitors. We looked at records, the environment, observed practice and spoke to people about what they felt about the home. We also asked the people who live at the home, their relatives, staff and other professionals to complete short questionnaires about their experiences. The Manager completed a quality self assessment. Evidence from all of these sources is used to help us make our judgements. Ten people who live at the home, three visitors, two members of staff and two professionals who work with the home completed questionnaires. Most people said that they were generally happy with the care and support they got and that they always or usually liked the food. Some people felt that the home did not provide activities which they enjoyed. Two people felt unhappy with aspects of their care. One person said that they felt the standard of care had got worse over the last year and a half and that staff were ‘always in a hurry’. All the visitors felt that there was not enough staff. One person felt that complaints were not handled well and they felt that activities could be improved. The staff members said that they were supported and had training they needed. One said that there had been an improvement in the amount of resident meetings. The other said that they did not feel staff were given the opportunity to contribute their opinions. Some of the people who spoke to us said that they were very happy. Some people had lived at the home for several years and complimented particular members of staff for their kindness. One person had recently moved to the home and said that that they had been well supported. What the service does well: Most of the people living at the home are happy there. There are well kept grounds and the home is situated in a pleasant area. People use local shops and go out alone, if they are able. There are some well organised group activities. The monthly quality checks made by the organisation are good. Cecil Court DS0000017354.V341037.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. Cecil Court DS0000017354.V341037.R01.S.doc Version 5.2 Page 7 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.V341037.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4 & 5 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People thinking about moving to the home are given some information and are able to visit the home. Some people would like to have better information. The staff assess individual needs to make sure the home is suitable for that person. EVIDENCE: There is a Statement of Purpose and Service User Guide for the home. Copies of these are given to all residents. The Manager said that these have been updated and improved during the last year and that the organisation’s website has improved. Some of the people completing questionnaires said that they did not have enough information to help them make a decision about moving to the home. The Manager should consider other ways to help give information to potential residents. One person suggested that visitors should be given a leaflet outlining house rules. Cecil Court DS0000017354.V341037.R01.S.doc Version 5.2 Page 9 People considering moving to the home visit for a day and share a meal with other residents. The senior staff carry out an assessment during this time. Families and other professionals give information to help form the assessment. The Manager said that they aim to make the assessments more person centred and give the person receiving the care more opportunities to tell them what they want. Some people were having their needs reassessed at the time of the inspection because their needs had changed. Some staff have had training in different health care conditions to help them work with people when their needs have changed. The Manager hopes that all staff will have more opportunities for training in these areas. The Manager said that she had collected information on dementia to share with families. Cecil Court DS0000017354.V341037.R01.S.doc Version 5.2 Page 10 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 resident has their care needs recorded, but not in a way that is accessible to them. Information on personal and healthcare needs is not always clear. Information needs to be improved and staff need to focus more on individual wishes and needs. There have been some improvements to medication however there are still some areas which need to be improved. EVIDENCE: There is a care plan for each person which is recorded on the computer. These are printed out and held in files on each unit. The information is repetitive in places and there are unnecessary charts and information. This is confusing for staff and makes them inaccessible for many of the residents. The layout of the files means that there is a lot of information stored in front of the actual care plan and it is difficult to access. Cecil Court DS0000017354.V341037.R01.S.doc Version 5.2 Page 11 The layout, language used, terminology and the way information is presented is not accessible to residents. Residents have not been involved in creating their care plans. A lot of the information focuses on how care tasks can be achieved. Some of this is similar in different people’s care plans. One care plan seen referred to the ‘resident’ not the name of the person. There is limited information on individual wishes and preferences and there needs to be more focus on these. Some of the sections in care plans seemed to have been completed irrespective of whether a person had a need in that area. For example most night care plans recorded the position someone slept in, even when people were independent in this area. The information is therefore irrelevant. Oral hygiene charts had been completed when people were independent and did not require assistance in this area. The staff need to find a more person centred approach to their work and to care planning. With the exception of one unit, where people seem to have been more involved in the development of their care plans, plans were generally not signed by the resident. In most cases they were also not signed by the relative and some entries were not signed and dated by staff. The information on social needs and interests, including life histories was very limited in most care plans. This information is important to make sure individuals can follow their interests and also to give staff a clearer picture of the people they are working with. The staff need to be proactive in seeking this information, particularly where residents are confused or are unable to give this information. Some of the information in care plans was contradictory and did not make sense. For example one care plan stated that someone needed continence aids, while an assessment on this person said that they did not. Another care plan said that someone had no cultural needs, however recorded in another section that their religion was Church of England. In another care plan referred to someone being obese in one section, having no weight problems in another and being at nutritional risk in another. The care plan also stated that the person, ‘needs to loose weight’. There was no evidence to suggest this was for a medical reason and it appeared that the judgement had been made by the person writing the care plan. Care plans contain risk assessments, but these do not inform staff of how the adverse effects of risk taking can be minimised or how people can be enabled to take risks. Many of the risk assessments had calculations and scores which are meaningless to the person they are about and do not helpfully explain to staff the support that they need to give. Cecil Court DS0000017354.V341037.R01.S.doc Version 5.2 Page 12 Some of the needs identified in risk assessment, general assessments and profiles were not reflected in care plans. For example one person was recorded as having a soft diet in a profile about them. However the care plan recorded their diet as normal. Where people had experienced a change in need, the care plan had been updated. But in some cases old information had not been removed. So that the overall care plan contradicted itself and was confusing. Some of the terminology and phrased used in care plans and daily notes was not appropriate. These included referring to ‘grooming’, feeding’, ‘toileting’ and stating people had a problem, were ‘aggressive’ or liked to ‘wander aimlessly’. Sometimes people had identified a preferred name but this was not used throughout the care plan, or had been wrongly spelt. The Manager has introduced regular reviews of care plans. There are appropriate records for these but staff are not always using them appropriately and are not always involving the resident. For example one review asks the question ‘does this person like living at Cecil Court?’ There was nothing written in the review, daily records or care plan to indicate how the person felt about living at the home. One person told us that the staff did not always help people to have a proper wash. They felt that staff needed more training in this area. There is a medication procedure and all staff responsible for administering medication are trained. People who wish to look after their own medication are supported to do so if it is safe for them to. Medication management has improved and more regular checks are made to make sure records are accurate, staff are following procedures and medication is stored safely. Some further improvements are needed in record keeping as medication amounts were not always recorded, some allergies were not recorded on administration records and some staff were using unofficial symbols to denote what had happened when they went to administer medication. There was no key for these symbols and it was unclear what had happened. In one case a medication record advised staff of action to take if a person had a hypoglycaemic incident. However, there was no record to explain how staff would recognise such an incident. Some denture cleaning tablets held in the medication cabinet were not labelled. Cecil Court DS0000017354.V341037.R01.S.doc Version 5.2 Page 13 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 have been considerable improvements to organised group activities. However, there needs to be more work to make sure individual interests are met and to make sure the planned group activities take place. Visitors feel welcome at the home and are able to continue to care for their relative if they wish. People are generally happy with the food and the atmosphere at mealtimes has improved. EVIDENCE: There have been changes to some of the planned activities since the last inspection. These include a planned diversity meeting, men’s club and gardening group. There is also a regular baking group who make cakes, nail painting groups, film club and other activities. The men’s club was supposed to be held on one day of the visit. However, this did not take place. The person organising the group was not clear about why this was and did not seem to have planned a particular theme for the group. However, he was supporting a group of mixed residents to play a game of dominos, which they were enjoying. Cecil Court DS0000017354.V341037.R01.S.doc Version 5.2 Page 14 There are regular visits from local religious groups, including a Sunday church service, visits from a Polish priest for Polish residents and Holy Communion for those wishing to take this. Each month there is an international day aimed at raising awareness of different countries and cultures and also designed to be fun. Recent events included an Italian day and an Indian day. The residents also celebrated St George’s Day. The Manager said that people living at the home are asked for their views and opinions on how these special events can be improved. There are some planned trips to the seaside, Kew gardens and local pubs, shops and restaurants. There are free passes available for relatives to take people to Kew Gardens, which is very close to the home, on individual outings. The residents and staff have been working to create some attractive ceramics depicting Kew Gardens through the seasons. This work is displayed in the entrance hall and is a lovely welcome for visitors and residents alike. The visitors who completed questionnaires felt that there should be more improvements to activities. Although there is a range of planned activities and these have improved. The staff need to think more about the individual needs of different people. Each resident is allocated a keyworker and this person should take time to find out about their interests and what the home could do to meet these interests. Records entitled ‘keywork diaries’ within care plans were often periodic and recorded things to do with personal care. Sometimes there was no record of activities or social interests in people’s care plans or daily records. One resident told us that she would like to go out but was never given the support to do this. Another person said that they would like to spend more time in the garden but they were not allowed to go there alone and the staff were never available to take them. In one unit the staff were listening to a pop music station which was not the residents’ choice. The radio and TV were both on and the noise was overwhelming and confusing. One person said that they felt the staff did not have time to help and support them and that this made them feel insecure. Relatives said that the staff usually contacted them about important matters. They said that they were welcome to visit at any time. Over the past year the Manager has organised for more regular residents meetings. Residents from each unit meet with the staff who support them and discuss things that they want to. They are informed of changes and are able to contribute their ideas. Cecil Court DS0000017354.V341037.R01.S.doc Version 5.2 Page 15 Mealtimes at the home have improved so that there are now menus on each table and people are able to help themselves to vegetables from dishes on each table. We observed people taking lunch in one unit. The staff offered them choices, drinks and there was a pleasant atmosphere with music and conversation. People were able to come to the dining room at a time of their choosing and staff did not pressure them to stay if they wanted to leave and eat the remainder of their meal in their room. Staff asked people about their enjoyment of their meals. This is a significant improvement to mealtimes observed at previous inspections. There is a choice of main meals and people are asked to make their choices a day in advance. During the inspection residents of one unit were asked to choose their next day’s meal directly after they had finished lunch. The Manager said that this was not normal practice. Staff should not do this as it is difficult for people to think about their next meal when they have just eaten. Most people said that they liked the food. One person said, ‘the food is always superbly served’. Another person said, ‘the food is excellent’. One person did not like the food and said that it was not always hot and that they would like healthier options. One person said that jugs of water in bedrooms were not refreshed every day. Cecil Court DS0000017354.V341037.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 – 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. There are appropriate complaints and protection procedures. Not everyone is happy about the way in which their concerns have been handled. EVIDENCE: There is an appropriate complaints procedure and a record of all complaints and concerns. Two people who contacted us said that they were not happy with the way complaints had been handled. One person said that they felt no one had listened to them or cared about them. The other person said that a complaint they made was handled badly. The organisation has its own procedure on abuse. The home also has copies of the London Borough of Richmond and London Borough of Camden adult protection procedures. All staff have attended or are due to attend training in protection of vulnerable adults organised by the London Borough of Richmond. Staff induction also includes information on abuse. Cecil Court DS0000017354.V341037.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 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 comfortable and appropriate environment, which is generally well maintained. Maintenance work in some areas and better cleaning would improve the environment further. EVIDENCE: The home is situated in a residential area of Kew, with a small amount of its own parking. There is free roadside parking. The home is set in attractive and well kept groups. It is divided into four separate units each with its own dining area, bathrooms, lounge and kitchen. There is also an activities room, separate kitchen, laundry areas and staff offices and rest rooms. Three of the bedrooms have en suite showers and all rooms have en suite toilets. People are able to personalise their rooms. We saw that some people Cecil Court DS0000017354.V341037.R01.S.doc Version 5.2 Page 18 had brought their own furniture, furnishings and belongings. Some bedrooms had attractive signs for the doors. The staff should make sure everyone has the opportunity to identify their bedroom door in a way they want. The bathrooms and toilets should also be appropriately labelled to help people to identify these. In general the building is in a good state of repair. There are some decorative needs and some carpets are marked and stained, some areas needing repainting. Some of the furniture in communal rooms does not match and would benefit from replacing. There are a variety of personal touches, such as the Kew Garden ceramics, coffee tables in the lounges and a very well kept garden. However some things had been overlooked, such as a clock telling the wrong time. Two domestic staff are employed. The home was clean and odour free throughout the inspection visit. Some people commented that the home was generally clean and tidy. Although some people felt that thorough cleaning did not always take place. One person commented that cleaning staff rarely dusted behind furniture. Some of the baths and handwash basins had a large amount of limescale which needs to be cleaned. A soap dispenser in one bathroom was empty. A bathroom floor was stained and there was no plug in one bath. A programme of regular cleaning to prevent the build up of limescale should be developed. The Manager reported that she is drawing up a cleaning schedule for staff to attend to certain tasks. Cecil Court DS0000017354.V341037.R01.S.doc Version 5.2 Page 19 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. The residents are supported by staff who are well trained and supported. Staffing shortages over the past year and a reliance on temporary staff has affected some people however this problem is being addressed. Staffing levels in one unit mean that it is difficult for staff to achieve some tasks. EVIDENCE: There have been some staff vacancies at the home. The Manager and Deputy Manager were interviewing to fill these around the time of the inspection. Some of the staff vacancies were senior positions and they were keen to fill these. The recruitment procedure for staff includes a written test and formal interview. Criminal record checks and references from previous employers are made before someone is employed. We saw information in staff files for the newest members of staff and these were appropriate. The Manager has reallocated some staff and has made changes to the senior staff team to address problems that have been identified. These include more thorough supervision of staff at night time. Some people who contacted us said that they felt staff shortages were a problem. One person said that the staff were always in a hurry and another Cecil Court DS0000017354.V341037.R01.S.doc Version 5.2 Page 20 said that they just focused on chores not spending time with residents. Some people felt that there were not enough staff during the evenings and at night. Some people commented that they felt the staff looked miserable and did not take the time to stop and chat. Professionals who contacted us said that they felt the permanent staff were caring and helpful but that the home relied too much on agency and temporary staff. There have been changes to the staffing rota so that there is a longer over lap of staff in the middle of day. One of the units has only one member of staff on duty for most of the day and even with this overlap of staffing, the staff on this unit said that some things are difficult to achieve. They said that at breakfast and lunch times, when people want a bath and when people want to go out or have a bath, it can be difficult to meet individual needs. The organisation supports staff to take NVQ awards. Over half the staff have been trained to NVQ Level 2 or above. There is a new induction pack for staff which covers additional training needs such as person centred planning. This leads into NVQ training. The Chef, Administrator and domestic staff are all undertaking relevant NVQs. The Deputy Manager is undertaking specialist management training and NVQ mentoring. The organisation provides a range of training for staff. The Manager keeps records of training which staff have attended. These indicate that most people have had training in key areas, but that some people are due for refreshers in manual handling and first aid. The Manager said that some training DVDs had been purchased and that staff were using these. These included food hygiene and health and safety. Not all staff have had training in dementia care. The Manager said that this was being organised for everyone and that some staff had undertaken an indepth course in this area. They have shared some of what they have learnt with others. The Manager hopes that some in house training can be provided so that everyone has the opportunity to have the information they need to work with people who have dementia. There are no qualified manual handling trainers working at the home. There is a short course which staff can undertake, with regular updates, which would enable them to train others and to make appropriate checks on whether techniques are being followed correctly. It is strongly recommended that some of the senior staff undertake this training so that they can support the care staff in this area. There are regular staff meetings and the staff take it in turns to chair these and take minutes. All staff have regular individual meetings with their line manager. Cecil Court DS0000017354.V341037.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The residents have opportunities to contribute to monitoring and quality improvement, but some people would like to have more of a say in this. The home keeps accurate records of any money held on behalf of residents. Regular checks on health and safety make sure the environment is kept safe. EVIDENCE: The Manager has been in post for just over a year. qualified. She is appropriately There are copies of meeting minutes. There is a file of cards and compliments from residents and relatives. Cecil Court DS0000017354.V341037.R01.S.doc Version 5.2 Page 22 The organisation conducts regular checks on the home to make sure different areas are up to standard. Some of these checks are themed and focus on a particular area, such as food, activities, accidents or the environment. The records of the checks are sent to the CSCI and contain actions for improvements. These are a positive part of quality monitoring in the home. The Manager said that she has tried to create more opportunities for residents and staff to contribute their ideas. However, one person who lives at the home said that they did not feel the Manager respected the views of residents. She should consider how residents could be more involved in regular quality monitoring of the service. Small amounts of cash are held safely for people who wish to use this service. This money can then be used for small purchases or the hairdresser. The money is held securely and records of this are accurate. Regular checks on health and safety, including fire safety and first aid equipment are made and recorded. The Deputy Manager has developed a fire risk assessment for the home. Cecil Court DS0000017354.V341037.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Cecil Court DS0000017354.V341037.R01.S.doc Version 5.2 Page 24 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 12 15 Requirement The Registered Person improve care planning. includes: Timescale for action must 31/08/07 This Making sure care plans are accessible to the people they are about. Making sure information presented in a clear way. Making sure they focus individual needs and wishes. is on Involving the resident in making and reviewing the care plan. Making sure all information is accurate and is dated. Making sure staff do not record their own judgements and prejudices. Making sure old information is archived. The wording used must not be negative and must reflect the Cecil Court DS0000017354.V341037.R01.S.doc Version 5.2 Page 25 personal needs of each person, including their preferred name. Previous requirements 31/08/06 & 31/01/07 2. OP7 12 15 The Registered Person must 31/07/07 make sure care plan reviews record how the person receiving care feels about living at the home and their care plan. The Registered Person must 31/07/07 make sure individual social needs and interests are recorded and that care plans and daily routines include ways in which the staff can help them to meet these individual needs. The Registered Person must 31/07/07 make sure risk assessments: Consider ways to residents to take risks. enable 3. OP12 OP7 12 15 16 4. OP7 OP8 13 Record what support is needed to reduce the adverse affects of any risk. Are presented in a clear and accessible format. Are reflected in care plans. 5. OP8 12 13 The Registered Person must 31/07/07 make sure health care conditions are appropriately recorded and care plans in place to meet any health care needs. Previous requirement 31/08/06 & 31/01/07 Cecil Court DS0000017354.V341037.R01.S.doc Version 5.2 Page 26 6. OP9 OP8 13 The Registered Person must 31/07/07 make sure medication procedures are followed. Records must be accurate and include amounts of medication held. Allergies must be recorded on administration sheets. The staff must only use the approved symbols recorded in the key on each medication administration sheet or must define any additional symbols that they use. There must be clear information for staff on how to manage health care needs and when to administer ‘as required’ medication. All medication and tablets stored must be appropriately labelled. 7. OP14 12 16 The Registered Person must 30/06/07 make sure any radio station, music or TV programme is the residents’ choice and not that of the staff. 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 Manager should consider innovative ways to help give DS0000017354.V341037.R01.S.doc Version 5.2 Page 27 Cecil Court more information about the home to potential residents. 2. OP10 The Manager should make sure staff are trained and monitored so that they offer personal care in an appropriate manner. Residents should be asked for their opinions and feedback to make sure they are happy with the care that they receive. The staff should support each person so that they build up a good understanding of their life before they moved to Cecil Court, their interests and life events. This work is particularly important where people have become confused as increased staff knowledge about the person may mean that they have a better quality of life, meeting their individual needs at Cecil Court. The staff need to make sure organised activities are well planned, well advertised and take place. There should be an effective keyworking system where staff spend time listening to and meeting individual needs. 3. OP12 4. OP12 5. OP14 6. OP15 The staff should not ask residents what they want for the following day’s main meal directly after they have eaten. The residents should be consulted about what healthier food options they would like. Water jugs should be refreshed regularly. The organisation should talk to stakeholders to make sure they feel confident raising concerns and that they felt these are handled appropriately. People should be invited to label their bedroom door with a sign or name plate which reflects their personality and wishes. DS0000017354.V341037.R01.S.doc Version 5.2 Page 28 7. OP15 8. 9. OP15 OP16 10. OP19 Cecil Court 11. OP19 The Manager should consider replacing mismatching furniture and should make sure clocks throughout the building tell the right time. Cleaning schedules should include regular dusting, prevention of limescale build up and should make sure bathrooms are appropriately equipped with soap, towels and plugs. The staffing levels on the 2nd floor unit should be monitored to make sure people have opportunities to do the things that they want and to have individual care when needed. The organisation should organise for some senior staff to be manual handling trainers. The Manager should make sure all key training is regularly updated and that all staff are given training in dementia care. The Manager should consider ways to involve the residents more in the recruitment and selection of staff, development of procedures and quality monitoring. 12. OP26 13. OP27 14. OP30 15. OP30 16. OP33 Cecil Court DS0000017354.V341037.R01.S.doc Version 5.2 Page 29 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.V341037.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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