Inspection on 26/09/07 for Charnwood House

This inspection was carried out on 26th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Charnwood House 22/10/08

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 Charnwood House 49 Barnwood Road Gloucester GL2 0SD Lead Inspector Mrs Kate Silvey Key Unannounced Inspection 26th & 27th September 2007 11:00 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 Charnwood House DS0000069908.V344156.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. Charnwood House DS0000069908.V344156.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Charnwood House Address 49 Barnwood Road Gloucester GL2 0SD 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) 01452 523 478 01452 523 478 Apsley Park Ltd To be appointed Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (35) of places Charnwood House DS0000069908.V344156.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only with Nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Old age, not falling within any other category (Code OP) The maximum number of service users who can be accommodated is 35. 06/02/07 Date of last inspection Brief Description of the Service: This care home is registered to provide predominantly nursing care to 35 elderly people. There is a qualified nurse on duty at all times. Accommodation is over three floors and there is a shaft lift and stair lifts to help with access. There is a mixture of single and double bedrooms. One large communal lounge with access to an enclosed garden area is on the ground floor. Another smaller communal room is used as a dining room and quiet area for visitors, also on the ground floor. The home has been extensively extended property, and is set back from the main road. There are gardens to the front of the house and some off road parking is available. The care home is situated on a road leading to Gloucester City. It is therefore on a well serviced bus route. It is close to a doctors’ surgery, local chemist, public house, petrol station and local shops are approximately five minutes away by car. Gloucester railway station is accessible by bus. There is a notice on the main notice board informing visitors that the last inspection report produced by the Commission for Social Care Inspection (CSCI) is available on request. Charnwood House DS0000069908.V344156.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. This inspection took place over two days with one inspector. All the people accommodated were seen and many were spoken to during the inspection. Visitors were spoken to and staff were interviewed and observed. The accommodation and grounds were seen, including the kitchen and laundry facilities. Records were looked at, which included care plans, medication, recruitment, staff training, fire safety and staff supervision. The Commission received eleven service users surveys some of which were filled in by relatives on their behalf and 13 staff surveys. An Annual Quality Assurance Assessment (AQAA) of the home completed by the provider and the registered manger was sent to the Commission. The home’s Service User Guide states that the price of accommodation ranges from £390.00 – £850.00 per week, which includes room, light, heat, food, hairdressing and an appropriate level of care. Additional charges are made for chiropody, newspapers and magazines. The provider informed the inspector that the lowest price depended on what the placing local authority paid as some people are financed from other counties. The actual price for accommodation is given on application to the provider and there is a variation between a single and a shared room with a basic price of £550.00 for a shared room and £650.00 for a single room. What the service does well: Concerns and complaints are recorded and taken seriously and investigated by the manager and provider when required. The home was clean and generally well maintained, the manager stated that lots of the rooms had been decorated since the last inspection and there are plans to complete more refurbishment to provide a pleasant home for people. The home has good recruitment practices, which helps to ensure that people living in the home are protected. Charnwood House DS0000069908.V344156.R01.S.doc Version 5.2 Page 6 The home has a competent registered manager who has made many improvements to help with the smooth running of the home and an experienced deputy manager to support her. There is a quality assurance system, where people’s views are sought and any requests acted upon. The results of surveys are shared with the people in the home and their relatives/friends. Additional services like hairdressing, transport and escorts are provided when required. The staff seen during the inspection were considerate and caring towards people and did not try to rush them. The people living in the home that were spoken to individually said ‘the nurses were good and kind’, ‘staff were nice’, ‘I am not keen on agency staff’ and ‘I am happy to be here’. Visitors spoken to during the inspection were satisfied with the care provided and the communication with the staff. What has improved since the last inspection? There is an improvement in the information people have before they are admitted to the home, which includes an audiotape of the Service User Guide for people who are partially sighted. This enables people to make an informed decision about moving into the home. All people have the homes term/conditions and a contract as required to help protect their rights. The care plans have improved and have good person centred information, and the people in the home are included in their reviews when possible. New nutritional assessments have been completed for everyone and there were some good actions recorded to care for people at risk. The medication is generally managed well and the home now has a portable carrying case to transfer medication to other floors safely for administration. There has been progress with the choice and variety of the food provided and generally most people are satisfied with the quality. People are protected from abuse as all staff have now had safeguarding adults training and know how to recognise abuse and what to do if they suspect it. A policy and procedure is available for staff to refer to for guidance when required. There has been a lot of refurbishment in the home and the purchase of new furniture and bedding. More refurbishments are planned including a new kitchen and the decoration of communal areas. The first floor bathroom has been refurbished with new equipment and flooring and a sluicing facility to clean the commodes. The toilet adaptations improve the access for people and encourage their independence. Staff have completed relevant training since the last inspection to help meet peoples needs and safeguard them, which includes; the protection of Charnwood House DS0000069908.V344156.R01.S.doc Version 5.2 Page 7 vulnerable people, infection control, dementia care, managing challenging behaviours, health and safety and first aid. What they could do better: Experienced staff complete a pre-admission assessment, and there is information from relevant professionals. More detailed information could be included to ensure that all needs can be met. Verbal changes to people’s medication from the doctor should be managed appropriately to ensure safe administration. Generally people are treated with respect and privacy is upheld but some practices may need to be looked at to help ensure that this is always the case. The activity organiser has left and the home tries to ensure that people have activities they like. However, the manager is currently recruiting a new activities organiser to carry on the previous activity organiser’s good work. Some people would like more to do and to go out more. Information in the surveys completed by people in the home or their relatives, and what people told the inspector on the day are as follows; • not many activities at the moment, we used to do cooking and painting • there are sometimes activities my father can take part in, he has dementia • I like reading, watching television and knitting, doing exercises on a Thursday and listening to the keyboard player. We used to go out in the minibus. I can go to bed when I like • not enough activities, I cant remember having a survey asking us about what we want • it is very nice here but I would like more to do and go out more. The Roman Catholic priest comes to see me and I read and watch television. Staffing level reviews are not recorded to help identify shortfalls, and there may be a need to have additional staff in the evening during peak levels of activity for staff as people prepare for bed. More care staff should be trained to NVQ level two in care to help ensure that people receive a good standard of care at all times. Staff have received health and safety training, however, the person with the responsibility to assess the health and safety requirements of the home should have more specific training to help her complete the task well and maintain a safe environment for all. Charnwood House DS0000069908.V344156.R01.S.doc Version 5.2 Page 8 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. Charnwood House DS0000069908.V344156.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Charnwood House DS0000069908.V344156.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 & 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is an improvement in the information people have before they are admitted to the home, this includes an audiotape of the Service User Guide for people who are partially sighted. This enables people to make an informed decision about moving into the home. All people have the homes term/conditions and a contract as required to help protect people’s rights. Experienced staff complete a pre-admission assessment, and there is information from relevant professionals to help ensure that the home can meet peoples needs. EVIDENCE: Charnwood House DS0000069908.V344156.R01.S.doc Version 5.2 Page 11 People spoken to in the home and the relatives visiting said they had a Service User Guide and the registered manager has produced an audiotape of the guide for people who are partially sighted to listen to. All people living in the home have the new terms/conditions and contract if self-funding; the inspector saw a sample of these. Since the last inspection the home has a new registered manager who, with the deputy manager, completes the pre-admission assessments. The pre-admission records for a person recently admitted to the home were seen. There was an assessment and care plan from CACD (Community and Adult Care Directorate) and discharge information from the hospital where the person was staying. The CACD assessment/care plan omitted the new diagnosis of diabetes. However, the homes pre-admission assessment seen covered most areas but there was little room to record many details about the person. The manager should consider using a format where more detailed information can be recorded in this important assessment, to help ensure that all adaptations and suitably qualified staff are available to meet individual assessed needs. The record did not have an area for recording mental state and cognition, which may impact on the other people living in the home and require careful management with regard to the environment, staff training and staffing levels. However, information from the new registered manager, since the last inspection, identified that serious consideration is given before people are admitted with mental health needs. Healthcare professionals assessments where previous support has been given should be included in assessments, and information regarding the need for sensory checks, and when they were last completed, for example the optician. This record is a baseline for monitoring needs and then reviewing progress and should be complete The record was not signed which would be good practice. Charnwood House DS0000069908.V344156.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The care plans have improved and they are well set out with person centred actions and regular reviews to help ensure that people needs are fully met. Healthcare professionals are generally involved with people that require additional support to help ensure that they receive the best up-to-date care. The medication is well managed and the home has equipment to ensure medication is safely transported between floors. However, a verbal change of a person’s medication, from the doctor, had not been managed appropriately to ensure safe administration. Generally people are treated with respect and privacy is upheld but some practices may need to be looked at to help ensure that this is always the case. EVIDENCE: Charnwood House DS0000069908.V344156.R01.S.doc Version 5.2 Page 13 Three care plans were looked at in detail and others were seen during the inspection. Every person was seen and spoken to during the inspection many individually. The care plans seen were good and there were detailed records including clear person centred actions for staff to follow. The plans seen had personal profiles about people’s life, what they valued and their preferences. Manual handling and risk assessments had been completed including the risk of maintaining skin intact over pressure areas. Currently there were no pressure ulcers recorded and pressure relieving equipment was seen in use for most people. Adaptations were seen to help people use the toilet and mobilise. Continence care was well recorded but observation revealed that the storage of used pads was not managed well in all cases and a person living in the home was accessing the sluice bin, which was sometimes full and there was not enough disposal bags provided. The bins provided in the sluice should be foot controlled to aid infection control and it is advisable that people living in the home should not access this area. The bins for incontinence pads in people’s bedrooms, to promote independence, should be lined to prevent any odour and disposal bags provided. Hand cleaning gel, glove and plastic apron dispensers are easily accessible on each floor to aid infection control. The manager stated that the home has a copy of ‘Essential Steps’ a department of health guidance on infection control, and is planning to use this to update the homes infection control policy and procedures. A wound care plan seen was descriptive but there was no measurement or dressing type recorded, however, there was advice and support from the district nurse. It is recommended that a more detailed record be kept to help chart the healing progress, which may include a measured photograph. There are four people with diabetes, one insulin dependant and all have regular blood tests and their diet and medication is monitored and reviewed. The need to have support from a diabetic nurse specialist was discussed and may mean that blood glucose levels for some could be evaluated over several months and weekly tests in the home may not always be required for noninsulin dependant people. The person with insulin dependant diabetes had a good record of blood glucose levels throughout the day. A protocol for managing the diabetes with regard to what action to take when blood glucose levels fluctuate should be recorded and it is recommended this be kept with the medication administration charts in case of an emergency. A new nutritional screening tool has been used for all people and a clear method for determining the body mass index is used and good records support Charnwood House DS0000069908.V344156.R01.S.doc Version 5.2 Page 14 the people who need careful monitoring. The Malnutrition Universal Screening Tool (MUST) chart, used for people at risk, is scored monthly and there is a food record chart of all oral intake including complimentary enriched drinks and soups. People assessed as a high risk nutritionally are monitored weekly and the doctor is informed. This is very good practice and examples were seen of clear records and staff sensitively helping people to enjoy their meals. A person who was admitted from hospital and could not mobilise or eat a normal diet has a Percutaneous Endoscopic Gastrostomy (PEG) feed tube with now only a small amount given each evening, to increase their weight. This person now enjoys a normal diet with support from the Speech And Language Therapist and is able to walk due to the dedication of the staff. Two other people admitted to the home unable to mobilise were now able to walk with help from the care staff. All care plans are reviewed monthly or more often when required. The reviews seen could be more detailed and may be a summary of the daily records where care actions have been referred to. When possible people sign their own care plan reviews, or there was evidence of relatives signing for them. Accidents are recorded and the last audit covering March – August 2007 was seen there were thirtytwo accidents, three at night only, involving sixteen people falling. Preventative action included staff checking people every 30 minutes in one instance and special mats are used on the floor at bedtime. It was recommended that the home explore the use of pressure mats to alert the staff to people beginning to move about. Healthcare professional visits were well recorded with detailed information, this included support from the consultant psychogeriatrian for one person and the district nursing services for specialist wound care. One person with her own teeth, however, had not seen a dentist for two years. The people living in the home that were spoken to individually said ‘the nurses were good and kind’, ‘staff were nice’, ‘I am not keen on agency staff’ and ‘I am happy to be here’ Visitors spoken to during the inspection were satisfied with the care provided and the communication with the staff. Observations by the inspector generally were that the staff treated people with respect and preserved their privacy. Some staff, however, used inappropriate terms of endearment or pet names this should be avoided unless requested by people living in the home. The use of ‘dear’ and ‘love’ are less desirable than using a persons name and can be seen as demeaning. There was a dry wipe board in the corridor displaying which people went to bed at certain times and needed care. This new idea may help staff but it is undignified for people in the home and should not continue. The hairdresser was completing everyone’s hair in the main lounge, which offered little privacy as some people were eating their lunch. Charnwood House DS0000069908.V344156.R01.S.doc Version 5.2 Page 15 The home has started a new monitored dosage administration system, which has been running for three months and the supplying pharmacy is due to complete the first audit soon. The manager completes a tablet count in the middle of each month, it is recommended that this is recorded as part of a general audit to ensure correct administration. Staff were seen administering medication safely and there is a small lockable metal storage unit for transporting medication from the trolleys on each floor to the lounge. One trolley, a medication cupboard and fridge were inspected. There were appropriate stock levels, it was well organised, clean and the fridge temperatures had been completed. Liquid medication was dated when it was started. A controlled drugs audit completed was correct, and the nursing staff complete a weekly CD audit. The medication procedure is kept in the office, which staff should always have access to, there was an up-to-date medication reference. The homely remedy list for each person was signed by the doctor, so that only medication known by him is given, however, the procedure should indicate a length of time or how many doses can be given before the doctor is contacted. The administration records were generally well completed and variable doses were indicated. Not all ‘as required’ medication had a protocol which would help to ensure staff know what to give. This should be completed as good practice and included in the care plan and information available with the medication administration record. During the case tracking of individual medication records staff had continually altered an insulin dose at the start of each month. The prescription when checked indicated a different dose and the nurse on duty was able to find a previous verbal record in January 2007, not signed by staff, from the doctor to alter the dose. However, the surgery continued to prescribe the unaltered dosage. The nurse on duty agreed to check with the surgery to ensure the correct dosage was printed on the prescription and administration record from the pharmacy. Staff must ensure that two people sign a verbal request for change from a doctor and that subsequent records are correct. A protocol should be kept with the medication records for people requiring insulin for use in an emergency. Currently there was no one self- medicating in the home. Charnwood House DS0000069908.V344156.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home tries to ensure that people have activities they like and are currently recruiting a new activities organiser to carry on the previous activity organiser good work. Some people would like more to do and to go out more. Diversity issues are addressed and people are able to have choice and control over their daily living activities. Friends and relatives support the home and help with activities and are welcomed in the home. There has been progress with the choice and variety of the food provided and generally most people are satisfied with the quality. EVIDENCE: The AQAA states that the home has a new activities programme including coffee mornings and the organisation of special teas. Musical events have been organised and outings, including boat trips. Recently the activities organiser has left and the manager has recruited another person who will start once recruitment records are complete. Charnwood House DS0000069908.V344156.R01.S.doc Version 5.2 Page 17 A relative spoken to said that people are taken out occasionally and seem to enjoy the change. The homes transport looks like an ambulance, this is inappropriate and staff say it is ‘embarrassing for people to travel in’. The relatives’ help to organise activities through the Friends of Charnwood, which they run with the homes previous provider. During the inspection the local priest gave people Holy Communion in the lounge. Different faith ministers visit the home to meet the needs of the people accommodated. There is information in the care plans regarding people’s preferences and the lifetime activities enjoyed by them. Information in the surveys completed by people in the home or their relatives say; • not many activities at the moment, we used to do cooking and painting • there are sometimes activities my father can take part in as he has dementia • recently there is always staff in the lounge to talk to us • staff are kind and understanding. Several people were spoken to in their bedrooms and told the inspector that; • • • • • I like reading, watching television and knitting, doing exercises on a Thursday and listening to the keyboard player. We used to go out in the minibus. I can go to bed when I like not enough activities, I can’t remember having a survey asking us about what we want it is nice living here I can do what I like, mostly like to watch television, but I go out with relatives sometimes it is very nice here but I would like more to do and go out more. The Roman Catholic priest comes to see me and I read and watch television. I stay in my room all day except to go down to have my hair done, I watch television, read the paper my daughter brings, and magazines. The kitchen was seen and the two catering staff explained the new menus to the inspector. The main meals from the menus are written on a board in large print for everyone to see and there is always another choice everyday of fish, chicken, cheese, omelettes or salads. People are asked the day before what they would like and a record was seen of the last six weeks. People dislikes are also listed. Special diets are catered for and the staff were able to explain how they are provided. There is a list of people who are at risk from being underweight and extra whole milk drinks are given. Ten people have a soft diet where individual foods are served separately to look attractive. There were no specific soft consistencies recorded. There was plenty of fresh vegetables and products available for use. The kitchen will be refurbished soon as some equipment needs replacing. A new hot trolley had been returned faulty and the staff were waiting for another to arrive. Fridge temperatures had been recorded and the kitchen was clean. Charnwood House DS0000069908.V344156.R01.S.doc Version 5.2 Page 18 Food was being kept hot before people were served and staff seen helping people with their lunch in a sensitive and unhurried manner. Generally people were pleased with the food provided, comments from people about the food included; • wish we had more fruit to eat, some lunches are excellent, given unripe fruit and instant desserts for supper • always a good choice of food and staff will always do you something different. • good food, drinks are not always hot and some only small • food good I have sugar free jelly, homemade fruit cake and apple cake as I am a diabetic. Charnwood House DS0000069908.V344156.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. The information available to ensure people know how to make a complaint is comprehensive and staff take concerns and complaints seriously and make a record of both and respond appropriately. People are protected from abuse as all staff have had safeguarding adults training and know how to recognise abuse and what to do if they suspect it. A policy and procedure is available for staff to refer to for guidance when required. EVIDENCE: The AQAA states that a copy of the Service User Guide, which contains the complaints procedure, has been given to all residents and relatives. The complaints procedure is also displayed in the home in a large print format for people to read easily and the Service Users Guide audiotape available contains information about the complaints for people who are partially sighted. The registered manager stated that there had been one recent complaint and a full response had been given to the persons Power of Attorney regarding a financial matter. The computerised financial evidence concerning the complaint was seen by the inspector. It was evident that the person living in the home was still confused, and the registered provider, seen during the Charnwood House DS0000069908.V344156.R01.S.doc Version 5.2 Page 20 inspection, was asked to print the account and indicate how the Registered Nursing Care Contribution had been returned. All the surveys returned to the Commission from the people in the home or their relatives said they knew how to make a complaint. There was evidence in the daily records when concerns had been raised and were dealt with straight away. The Commission has not received any complaints about the service since the last inspection. All staff have had Protection of Vulnerable Adults training since the last inspection and the registered manager and deputy manager have had enhanced POVA training. There are additional documents about safeguarding people available in the home as a reference. There is information in the POVA folder about safeguarding people and ‘whistle blowing’. It was recommended that the contact telephone number and name of the local Adult Protection Team is added to the guidance. Charnwood House DS0000069908.V344156.R01.S.doc Version 5.2 Page 21 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): 19,21, & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The new providers are gradually updating the home and refurbishing the rooms providing a more pleasant home for people. There are plans to continue until all areas have been decorated and flooring and furniture replaced as required. The bathroom facilities have improved with the refurbishment of one bathroom. The home was clean and there has been an increase in the number of cleaning staff since the last inspection. EVIDENCE: Al the rooms were seen and most bedrooms had been personalised with people’s own possessions, which helps to make it feel more homely. Charnwood House DS0000069908.V344156.R01.S.doc Version 5.2 Page 22 Some of the rooms have been refurbished with replacement furniture, which includes the dining room furniture, there are new wardrobes and furniture still to come. Twenty new mattresses have been provided. Many people were seen with pressure relieving mattresses and chair cushions. The first floor bathroom has been refurbished with new flooring and a sluicing facility to clean the commodes. The toilet adaptations improve the access for people and encourage their independence. There were no hand washing facilities in the top floor sluice and an alternative should be provided to promote infection control. A toilet near the new bathroom needed a new toilet roll holder. There are no toilets on the top floor, which means people have to use a commode or access a flight of stairs with a stairlift. The large wet room on the ground floor is a good facility and is well used. The home was clean and generally well maintained, the manager stated that lots of the rooms had been decorated since the last inspection and there are plans to decorate the communal rooms within the next 12 months. Room five will be refurbished soon and many commodes will be replaced. The small conservatory used as a dining room is very hot in warm weather as there are no blinds and people do not use it, to ensure there is enough communal areas for people to use and sit comfortably this must be addressed. The carpet in room 10 requires replacing, this was discussed with the manager who was assessing the use of alternative flooring. It was noted that many bedrooms do not have a chair for visitors to use, this should be provided so that people can entertain visitors in their rooms if they wish. The ceiling outside the wet room on the ground floor requires attention where there was a water leak from a bathroom upstairs. The manager stated there are plans to refurbish this corridor as part of the communal areas refurbishment. The people had commented in their surveys returned to the Commission in July that the home was short of cleaners and that bathrooms needed more cleaning at the weekend. The manager stated that since then the home has two cleaners each weekday and one each weekend day. Most people spoken to during the inspection said their rooms were clean, one person said their room could be ‘cleaner’. Charnwood House DS0000069908.V344156.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Generally there are sufficient staff to meet peoples needs but there are times, particularly in the evening, when there may be a shortfall. The manager should complete a review of staffing levels to ensure there are sufficient staff at all times. The skill mix is appropriate to meet people’s needs. Forty percent of the care staff are trained to the standard of NVQ level 2 in care or above which falls short of the minimum required to help ensure that people are is safe hands at all times. The manager plans to increase this number and has provided additional relevant training for all staff since the last inspection. The home has good recruitment practices, which helps to ensure that people living in the home are protected. EVIDENCE: The inspector took a copy of the staff rota. Eight staff were on duty during the mornings of the inspection including the deputy manager and a Registered Nurse. Five staff are on duty from 14.00 – 20.00hours. Thirty people were accommodated but generally there are thirtythree. The new registered manager was on leave but came in during the first day of the unannounced Charnwood House DS0000069908.V344156.R01.S.doc Version 5.2 Page 24 inspection. The registered manager was not on the rota, there should be a record of her duties and staff and relatives should know when the manager is available. The deputy manager stated that there was enough staff at present. There were ancillary staff available to complete catering, cleaning and laundry duties, although according to the rota there were some days when there were no cleaning staff. Comments from the staff in the surveys and on the day were; • the home supports me well and provides training • I would like more time to spend one to one with people • excellent staffing levels and a high standard of care provided (RN) • the new manager has improved things greatly and is approachable and understanding • we need more staff • sometimes we are short staffed in the evening • we have a good manager now. The registered manager is planning to recruit another carer for the twilight shift in the evening. Agency staff are used to cover sickness and holidays and the deputy was trying to find cover for the following day during the inspection. The people living in the home were generally pleased with the staffing in the home, however, two people said that staff were either slow to answer the call bell or did not come. There should be a regular recorded review of staffing levels to ensure that the needs of the people accommodated can be met at all times. The record of the last monthly visit by the provider in August 2007 stated that ‘there should be more participation of the management team, including team leaders, on the floor, supervising and teaching the staff’. A record of the training staff have received or are completing was given to the inspector which included updates for the nursing staff. Twentytwo of the thirtythree care/nursing staff, which includes bank staff, completed dementia care training, and thirtyfive staff have completed infection control training, which includes ancillary staff, in 2007. Eight of the twentytwo care staff had completed NVQ level 2 in care and one is completing it, two are continuing with NVQ level 3 training. The deputy manager has completed NVQ levels 3 and 4 in care. Most staff had completed manual handling training and several care staff had completed food hygiene training. Twentyone nursing/care staff have completed ‘challenging behaviours’ training in 2007. Several staff records were seen and all had a copy of their training certificates. One carer expressed a wish to have palliative care training. The registered manager has four workbooks from Macmillan covering foundation training in palliative care. The intention is to start weekly meetings for staff as each book takes one month to complete. This will be an ongoing process to ensure all staff have this basic knowledge to build on. The manager stated that the home has strong links with the Primary Health Trusts Care Home Support Team who are able to advise them when required. Charnwood House DS0000069908.V344156.R01.S.doc Version 5.2 Page 25 The registered nurses have received medication update training recently and one nurse is the link for wound care and has had tissue viability training. Three recruitment records were seen, two for new members of staff about to commence who were waiting for their Criminal Records Bureaux check to come back, and one for a last employer reference. The recruitment methods were generally completed well. However, there was no record to indicate why there was a gap in one staff record of employment record. New staff complete a two day induction, not seen at this inspection. The manager stated that the induction had been reviewed in line with the new standards since the last inspection. Charnwood House DS0000069908.V344156.R01.S.doc Version 5.2 Page 26 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 adequate. This judgement has been made using available evidence including a visit to this service. The home has a competent registered manager who has made many improvements to help with the smooth running of the home. There is a quality assurance system, where people’s views are sought and any requests acted upon. The results of surveys are shared with the people in the home and their relatives/friends. The records seen indicate that peoples monies are managed satisfactorily, however, a person living in the home was unable to understand the process completely. There have been improvements in staff training to help promote health and safety but the person responsible for assessing health and safety in the home is not qualified or has not had sufficient training to complete this important task. Charnwood House DS0000069908.V344156.R01.S.doc Version 5.2 Page 27 EVIDENCE: The home now has a competent registered manager who is an experienced registered nurse, and there has been many improvements seen which indicates that the home is well managed and there is communication within all levels of staff to help maintain this. The staff spoken to have respect for the new manager and welcome the stability and progress made so far. The manager has already sent a questionnaire to all the people in the home and produced a bar chart of the findings, seen by the inspector. The findings were fed back instantly to the people living in the home, including any requests. The results were also shown to the relatives at their meeting as ‘Friend of Charnwood’ and posted on the relatives notice board. The manager intends to do a quality assurance survey every six months with a shorter version quarterly, and plans to include verbal responses from healthcare professionals. The registered provider completed a monthly assessment of the home and provides a copy to the Commission. A copy of the report is kept by the manager who actions any identified issues arising. Information provided in the AQAA acknowledges that the provider and manager have identified there are improvements to be made with regard to maintenance, staff training, care provision and staffing. The barrier to completing issues has been identified as lack of sufficient funding by the placing authorities. To reduce this impact the provider has increased the companies funding, and raises funds through organised activities within the home and through local organisations. The positive response from relatives and the feedback from the questionnaires help the provider to know that the service is giving value for money. Additional services like hairdressing, transport and escorts are provided when required. A copy of the providers business plan was seen which identified issues to be completed. The new manager has arranged supervision dates for all the staff and a sample of the new format to be used was seen. The registered manager supervises the registered nurses and the deputy manager supervises the care staff. The provider stated there are no personal monies held by the home. However, an example of the management of the RNCC contributions was seen as satisfactorily completed. The maintenance person at the home helps to ensure that issues identified in the maintenance book are completed promptly. The deputy manager is responsible for health and safety in the home and apart from NVQ level 4 training has not had any specific training for this important task. The last general health and safety risk assessment was completed in 2005, this Charnwood House DS0000069908.V344156.R01.S.doc Version 5.2 Page 28 requires updating. The maintenance person monitors and checks water temperatures in the home. Portable electrical equipment was being tested during the inspection. Fire safety records were complete and the last fire drill was completed in August 2007. Fire risk assessments are completed by an outside agency. There should be sufficient staff at night to complete a safe evacuation. The fire safety training record indicates that some staff have not had fire training and some last had fire safety training in 2006. The manager is reminded that it is recommended that staff, including any bank staff used by the home, must have fire training every six months and the night staff every three months. The AQAA provided indicates that equipment has been serviced and that there are policies and procedures to help ensure that people live in a safe environment. Information provided by the manager indicates that most of the staff have completed first aid, health and safety and COSHH training in 2007. This is an improvement and the first aid training for staff meets a requirement made in the last inspection report. Cleaning products were safely stored in a secure cupboard with a keypad and the AQAA states that the home has written assessments on hazardous substances, Control of Substances Hazardous to Health (COSHH). According to the information in the AQAA the shaft lift and stairlifts were last serviced in June 2007. The staff stated that the shaft lift often breaks down. During the inspection an insurance inspection of the lift was completed. Defects and recommendations are reported to the provider and anything requiring immediate attention is also report to Environmental Health. Please send a copy of the report when available to the Commission to confirm any required action, as there was some question about the safety of the lift door. When the lift breaks down the registered manager should inform the Commission, to comply with regulation 37 of the Care Home Regulations. Charnwood House DS0000069908.V344156.R01.S.doc Version 5.2 Page 29 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 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 2 X X X X 3 STAFFING Standard No Score 27 2 28 2 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 2 Charnwood House DS0000069908.V344156.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? No 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 9 Regulation 13(2) Requirement Timescale for action 30/11/07 2 19 23 The registered person must ensure that; • verbal changes to medication by the doctor are managed appropriately • there are protocols in the care plan for ‘as required’ medication • and there are protocols for diabetics that require insulin. The registered person must 31/12/07 ensure that these issues raised in the environment standard are addressed; • provide blinds for the dining area conservatory to help with the temperature of the room • replace the carpet in room 10 • provide a seat for visitors in each person’s bedroom. The registered person must ensure that more care staff are qualified to the appropriate standard of NVQ level 2 in care DS0000069908.V344156.R01.S.doc 3 27 18 (a) 30/04/08 Charnwood House Version 5.2 Page 31 to ensure that people have good care at all times. 4 38 13 (4) (a) The registered person must ensure that a competent person, that has had sufficient training, completes health and safety assessments of the home. The registered person must ensure that when the lift breaks down the Commission is informed. 31/01/08 5 38 37 30/11/07 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 2 OP7 3 OP7 4 5 6 OP7 OP7 OP7 Refer to Standard OP3 Good Practice Recommendations There should be a comprehensive format used for preadmission assessments with additional space for recording more detail. Wound care should be recorded in more detail to chart the healing progress accurately. The disposal of continence pads should be managed more efficiently taking into consideration infection control measures. Care plan reviews should be more meaningful and indicate any progress made towards identified aims. The use of equipment to alert staff to prevent accidents should be reviewed. The use of ‘pet’ names for people should be avoided, as it can be demeaning. And a board in the communal area should not be used for identifying people’s needs at bedtime. The transport for people in the home should not look institutionalised to protect their dignity. Alternative hand washing facilities should be provided in the top floor sluice room to promote infection control. There should be a regular recorded reviews of the staffing levels to ensure that peoples needs can be met at all DS0000069908.V344156.R01.S.doc Version 5.2 Page 32 7 8 9 OP12 OP26 OP27 Charnwood House times. The manager’s hours should be recorded on the staff rota. Charnwood House DS0000069908.V344156.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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 Charnwood House DS0000069908.V344156.R01.S.doc Version 5.2 Page 34 - 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. 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