CARE HOMES FOR OLDER PEOPLE
Cherry Tree Nursing Home Bledlow Road Saunderton Princes Risborough Bucks HP27 9NG Lead Inspector
Sue Smith Unannounced Inspection 12th July 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000019193.V294458.R01.S.doc Version 5.1 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. DS0000019193.V294458.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Cherry Tree Nursing Home Address Bledlow Road Saunderton Princes Risborough Bucks HP27 9NG 01844 346259 01844 342 698 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr A.S. Dhot Maxine Bennell Care Home 42 Category(ies) of Old age, not falling within any other category registration, with number (42) of places DS0000019193.V294458.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 50 Physically Frail Elderly Mentally Frail Date of last inspection 21st February 2006 Brief Description of the Service: Cherry Trees Nursing Home is an established care home registered to provide nursing care for up to 42 elderly persons; It is privately owned and managed. The home is situated in a rural location close to the market town of Princes Risborough. It is a two-storey building set in well-maintained gardens with a millstream and large millpond, which attracts wild life and birds. Accommodation is in single rooms with comfortable social areas. There are no rooms with ensuite facilities. There is a passenger lift to the first floor. All service users are registered with the local General Practitioner and have full access to local NHS Services through General Practitioner referral. The fees charged are presently £670 and £690 per week. Information pertaining to the current fees was received from the Home on the 30th May 2006. Additional costs exist for such things as hairdressing, newspapers and personal toiletries. Information to support potential Service Users and their families to make a decision for admission to the home is provided in the homes Statement of Purpose and the Service Users Guide, which are provided to potential Service Users, with additional copies held in the home. DS0000019193.V294458.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the first key inspection of the service since the implementation of IBL2 (Inspecting for Better Lives). The inspection was undertaken on the 12th July 2006 over 7 hours. The Manager was available throughout the inspection. The Inspector used a triangulated methodology to complete this inspection, pre-inspection information such as the previous report and discussion and correspondence with the Proprietor was used in the planning process to ensure hypotheses were formulated to support the inspector to explore issues of concern and verify practice and service provision. In addition feedback surveys received, which included the views of Service Users, Families and Staff, were used in the planning process. During the inspection a variety of documentation was assessed, which included Careplans, Risk Assessments, Pre-Admission Assessments, Menus, Rota’s, Training records and Recruitment records. In addition a full environmental tour took place, which identified any issues of concern. The Inspector identified four Service Users for Case tracking, speaking with these Service Users and available family members, and assessing the available information held in the home relating to the care provision for these Service Users. In addition the Inspector met with three other Service Users and five visitors during the day to gain their views on care provision. Service Users and family members were happy with the care and support offered by the staff, they were complimentary of the friendly, sensitive and respectful approach of the team. The Inspectors observed positive practice throughout the day. What the service does well:
The home is managed by a suitably qualified and experienced Manager, with many years experience in the care of Older People, she holds a current Nursing and Midwifery Council registration and has maintained her training and professional development. Feedback throughout the inspection and previous inspections is of an approachable and professional Manager. The Manager is supported by well-informed and professional private Providers who operate other homes in the County.
DS0000019193.V294458.R01.S.doc Version 5.1 Page 6 The Manager ensures that all potential Service Users have a pre-admission assessment, information received from placing authorities, G.P.’s and hospitals is used to support the assessment, in addition the Service User and family members are spoken with to determine any additional needs that may not have been identified previously. Careplans are formulated on admission using a history document, which identifies what needs to be met initially; from this nursing plans are written which give clear and detailed directives to staff on how these needs will be met. These were found to be of a high standard with the emphasis placed on meeting the needs in a manner preferred by the Service User. Service Users are able to voice their concerns or complaints without fear of reprisal, the Manager is described as approachable and someone who will attempt to resolve issues of concern quickly with mutually agreed outcomes. A formal complaints procedure is in place should this be required, there have been no formal complaints made since the last inspection. The Home ensures the protection of its Service Users through its training programme and policies, which support and promote Service Users to maintain control over their lives. A clear Protection of Vulnerable Adults Policy is in place, which is in line with the local authority policy and its reporting procedures. Care is implemented in a sensitive and respective manner, taking into consideration the routines of the individual and how they would prefer to be supported. Staff were knowledgeable of the needs of the Service Users and how to support them to maintain their independence. Activities are offered at the home, which are appropriate to the needs of the Service Users. A dedicated Activities Coordinator is in post with an additional member of the team designated to support the programme. Training has been undertaken by Activities Coordinator to support her in the role. All Staff receive mandatory and service specific training such as Dementia Care, Incontinence, Parkinson’s, Infection Control and Constipation. The Manager ensures new courses are identified periodically to ensure they continue to deliver a professional service. NVQ training is in place at the home with new ways to motivate staff to sign up for this training being explored by the Manager. The home has adequate numbers of staff who are either trained nurses or Carers, flexibility in how the hours is allocated is evident to ensure the changing needs of Service Users can be met. Robust medication procedures are in place, which support Service Users. There have been no reported medication errors with all documentation and systems found to be maintained to a high standard. The implementation of
DS0000019193.V294458.R01.S.doc Version 5.1 Page 7 additional storage facilities in the home has enabled them to fully meet this standard. A variety of meals, which are both nutritional and appealing, are offered, home baking and snacks are offered throughout the day. The kitchen is well managed with no outstanding requirements or recommendations from the Environmental Health inspection. Service Users requiring support during meal times are given this support in a relaxed and sensitive manner. The environment is well maintained, providing single accommodation bedrooms to all Service Users. There are no ensuite facilities presently however toilets and bathrooms are situated in close proximity to bedrooms to meet the needs of Service Users. The home provides large communal spaces for Service Users to use with televisions, reading material and music systems provided for their enjoyment. The home is set in a large and picturesque garden with a millpond providing an abundance of wild life for Service Users to enjoy. The Garden is accessible from the ground floor with level patio areas suitable for wheelchairs and mobility equipment. Shaded seating is available throughout the garden, providing a relaxing and much used outdoor environment. What has improved since the last inspection?
In response to a requirement set in the last inspection report, the home has purchased additional medication storage facilities for such things as Lactulose and Senna, this has enabled them to appropriately administer all medications and maintain a clear audit trail. The meeting of this previous requirement has enabled the home to fully meet Standard 9. The environment continues to be well maintained with a programme of decoration in place. Careplans continue to be maintained to a high standard with the emphasis placed on providing plans, which are reflective of the needs and preferences of Service Users. The Manager and her team are working hard to standardise the quality of these plans.
DS0000019193.V294458.R01.S.doc Version 5.1 Page 8 The Manager and Providers continue to operate a professionally run service, which is reflective of a ‘good service’. All documentation required under regulation is provided to the Commission within the recommended timescales, there is an open dialogue between the Providers and the Commission, which is transparent. What they could do better:
The home has received one requirement under health and safety for selfclosing mechanisms to be repaired to ensure all doors are closing effectively. This requirement has not affected the quality rating or assessment of the standard, as the home had previous to inspection contacted the contracted company to organise a date for them to resolve this issue. It was noted during the inspection that locks fitted to bathroom and toilet doors (in response to requests from Service Users and family members to protect their privacy and dignity) were not of a type that could be opened from the outside should an emergency occur. A recommendation has been made for these to be changed as soon as is reasonably practicable. This was discussed during the inspection with the maintenance person who was receptive to the recommendation. In addition it is recommended locks be fitted to the sluice room doors, presently there are no hazardous products stored in this area, this recommendation is made to maintain the ongoing protection and safety of Service Users. The home are in the process of developing their quality audit systems to ensure they are representative of the home and organisations requirements. As the Proprietors have other establishments in the County it is recommended the Manager meet with the Proprietors and other Managers to develop these systems as quickly and efficiently as possible. The Manager does need to tackle the lack of motivation shown by staff to sign up for NVQ training, this is an ongoing issue for the Manager with the number of NVQ trained staff reflective of 18 , there is a further 4 members of staff working towards these qualifications which should support the home to raise its percentage. Staff need to be made aware of the importance and future necessity of achieving an NVQ qualification. DS0000019193.V294458.R01.S.doc Version 5.1 Page 9 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. DS0000019193.V294458.R01.S.doc Version 5.1 Page 10 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 DS0000019193.V294458.R01.S.doc Version 5.1 Page 11 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good; this judgement has been made using available evidence including a visit to the service. Pre-admission assessments are undertaken to ensure the home is able to meet the needs of potential Service Users prior to admission. EVIDENCE: The Manager ensures all potential Service Users have a pre-admission assessment to identify whether the home is able to meet their needs. The Manager or a suitably trained member of the team undertakes these. Information received during this assessment includes speaking with the Service User or relatives to ascertain additional needs that may not have been identified in the hospital or Care Managers Careplan. DS0000019193.V294458.R01.S.doc Version 5.1 Page 12 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is good; this judgement has been made using available evidence including a visit to the service. Individual plans of care are in place, which are reflective of the Service Users needs, with care implemented in a manner preferred by Service Users. The home has robust medication procedures in place, which are reflective of current guidance, ensuring the protection of service users. EVIDENCE: Careplans were assessed for four service users for casetracking purposes. Careplans were found to be up to date and relevant to the current needs of Service Users. A starting point for formulating the Careplans is a History on Admission document which contains such things as current medication, social/home background, observations on admission, personal hygiene needs, night care, mobility, memory, dentures, hearing, sight, elimination, hobbies, communicating/socialising, eating & drinking, personal effects and risk assessments. These were generally well maintained, however one document
DS0000019193.V294458.R01.S.doc Version 5.1 Page 13 had not been signed by the Key Nurse, the home are reminded to ensure all documentation is reflective of necessary signatures and dates. Information from the History on Admission is then used to establish individual nursing plans. The quality of these was generally good, with one Nurses Careplans identified as excellent. These were found to be reflective of Service User preferences, were clear and inform the reader how to meet the Service Users needs in a manner preferred by them. The Manager is now using those Careplans as a template for the expected quality for the home. The home currently has two Service Users with a Pressure Wound; the needs of these Service Users are well managed with the support of the PCT Tissue Viability Nurse. Clear plans were evident for the management of these wounds, which were reflective of review. Other necessary assessments such as manual handling, weight monthly Blood Pressure Monitoring and Pulse rates were all found to be up-to-date, signed and dated. The Careplans have a separate section relating to night time care, these were up-to-date and generally of a good standard, however the information as to how staff are going to achieve the Nursing Plan was not as detailed as the daytime plans. It is suggested these are formulated using the same principles and detail as the daytime plans to ensure the Service Users needs and preferences are maintained. The home has robust medication procedures in place, which are in line with current guidance. MAR (medication administration records) were maintained to a high standard with no evident gaps. All medication is stored in metal lockable facilities, which were found to be clean and tidy with no out of date medication stored. Additional metal lockable cupboards have been purchased to ensure all liquid medications such as Lactulose and Senna can be administered using the individual bottles prescribed to Service Users. This is an improvement in the medication system, which has contributed to the home fully meeting this standard. All controlled drugs are stored appropriately and were reflective of double signatures for administration. It was suggested to the Manager that a daily audit system be put in place, which could be implemented by the night staff to further improve the system in place. The G.P. is undertaking regular medication reviews to support the systems in place. DS0000019193.V294458.R01.S.doc Version 5.1 Page 14 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good; this judgement has been made using available evidence including a visit to the service. Activities offered at the home are suitable, flexible and enjoyable; ensuring the social needs of Service Users is met. Meals offered at the home are nutritious and appealing, ensuring the needs of Service Users is met. EVIDENCE: The home is continuing to provide a full activities programme, which is changed to adapt to the needs of Service Users and the season. The home were preparing for their annual Strawberry Tea day, which is open to families and friends, this is a well-attended function, which is greatly enjoyed by the Service Users. Service Users felt there was always plenty to do, however some felt they couldn’t join in with such things as quizzes due to failing eyesight. The Manager is continuously exploring new ways to implement activities taking into consideration the remote location of the home and the constraints this has on
DS0000019193.V294458.R01.S.doc Version 5.1 Page 15 accessing the local community, she has ensured the Activities Co-Coordinator has attended courses to support her in the role, which will further support the home to build on its current programme. An additional member of staff has also become involved in the activities planning which has contributed to the maintenance of this programme. The home ensures all Service Users are treated with respect and dignity, ensuring all admissions to the home is based on a needs assessment, with people admitted to the home with a variety of needs and from differing cultural backgrounds. The Home is proactive in its approach to maintaining the equality and diversity of its Service Users. Initiatives include providing alternative and specialist menus, religious services (or access to other denominations), open access to visitors, which includes pets, and exploring the option of television channels in languages other than English. As previously mentioned this is a difficult task due to the remote location of the home, this has been resolved by bringing the community to the home. Several groups have been invited to the home providing entertainment or support to Service Users. The use of advocates or representatives from cultural groups is open to all Service Users on request. The Inspector spoke with several Service Users who were enjoying the garden, shaded areas are provided with seating scattered around the garden and millpond. The Inspector was concerned that during her time in the garden there were seven Service Users sitting outside with no care or nursing staff within close proximity, on several occasions Service Users asked the Inspector for support, this was discussed with the Manager who immediately ensured a staff member was designated to this area. Meals are both appealing and nutritious; Service Users were generally happy with the meals offered and agreed there was plenty, with snacks and home baking provided throughout the day. Drinks and refreshments are served on request as well as the designated tea times. Staff were ensuring cold drinks were offered throughout the day to combat the summer heat. All special menus are provided were necessary ensuring liquidised food is presented separately to ensure it is visually, as appetising as possible. Staff are sensitive to the needs of Service Users who require support with their meals, ensuring support is unhurried and relaxed. The inspector observed one carer presenting a meal to a Service User who refused to eat, explaining that they would be back later to see if they had changed their mind and returning within a reasonable timescale to present the meal again. This was undertaken sensitively, with respect and concern for the Service Users wellbeing. The inspector was impressed with the manner in which this staff member undertook this task and compliments her on the positive outcomes she achieved. DS0000019193.V294458.R01.S.doc Version 5.1 Page 16 DS0000019193.V294458.R01.S.doc Version 5.1 Page 17 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. 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 the service. The home operates a complaints procedure, which is reflective of current guidance and timescales for action, thus ensuring Service Users, and significant others are able to raise their concerns appropriately. The home has a recently updated POVA policy in place, which is in line with current county guidance, thus providing additional protection to Service Users. EVIDENCE: There have been no formal complaints received at the home or directly to the Commission since the last inspection. A record of all complaints is held in the home, which was open to inspection. The home operates a complaints procedure, which is reflective of timescales for action, this policy is available to Service Users and significant others with a copy held in the home. Service Users reported feeling comfortable with raising any issues of concern they may have and that they would be listened to. Family members spoken with felt they could approach the Manager should they have any major issues of concern relating to the needs of their family member and that action would be taken to rectify the problem without the need for a more formal complaint. The approachability of the Manager and her team has ensured the numbers of concerns that have the potential to lead to a complaint are resolved quickly with responses and actions taken reflective of a good service. Feedback
DS0000019193.V294458.R01.S.doc Version 5.1 Page 18 received through pre-inspection surveys was fed back to the Manager to support improvements were concerns had been raised; this was done in a manner that protects the anonymity of the individual. The home have recently updated their POVA (protection of vulnerable adults) policy to ensure it is in line with the most recent Buckinghamshire Inter Agency Protection of Vulnerable Adults Policy and its reporting systems. There have been no protection issues raised at the home since the last inspection or ongoing issues that require resolution. DS0000019193.V294458.R01.S.doc Version 5.1 Page 19 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26. Quality in this outcome area is good; this judgement has been made using available evidence including a visit to the service. The home provides a well-maintained environment with suitable facilities and communal space to meet the needs of Service Users. EVIDENCE: The home is generally well maintained with a programme of decoration and maintenance in place. The domestic team take great pride in their work and ensure standards of cleanliness are maintained, the home was found to be cleaned to a high standard on the day of inspection, cleaning staff spoken with were knowledgeable of C.O.S.H.H. and Health and Safety Guidance and worked hard to ensure the home remained free from infection and unnecessary hazards, there were no items of C.O.S.H.H. left unattended with all cleaning equipment locked away when not in use. Signage for wet floors was being used throughout the home and cleaning schedules are in place, which include the cleaning of Service Users bedrooms.
DS0000019193.V294458.R01.S.doc Version 5.1 Page 20 The home provides laundry facilities, which meet the needs of the Service Users; there was no outstanding soiled washing in this area with a clean and safe environment maintained. Dedicated laundry staff were working hard throughout the day of the inspection to ensure the expected standard was maintained. The home have fitted hold open devises approved by the Fire Authority to all bedroom doors and approved communal areas, some of these are not functioning effectively and require further maintenance to ensure the risks involved with the spread of fire are minimised, the maintenance man is aware of this and has contacted the contracting company to resolve this issue. A requirement is made under standard 38 for this work to be completed as soon as is reasonably practicable to ensure the doors close effectively in line with current Fire Authority guidance. Locks have been fitted to several bathroom and toilet doors to maintain the privacy of Service Users, unfortunately these are not of a type that can be opened from the outside in an emergency, it is recommended these are changed to locks that can be operated from the outside should the need arise. In addition to the locks to the bathrooms and toilets there is also a need to fit suitable locking mechanisms to the sluice room doors, there is currently no items of C.O.S.H.H. stored in these areas which pose a risk, however to ensure the ongoing safety and protection of service users it is recommended locks be fitted. Apart from the above issues all areas of the home were found to be free from hazard, servicing records for equipment was open to inspection and all fire prevention guidance and systems are in place. There were no offensive odours present throughout the home with Service Users bedrooms cleaned and maintained to a high standard. Service Users and family members spoken with were complimentary of the facilities provided with requests for such things as additional shelving in bedrooms fed back to the Manager at the time of inspection. DS0000019193.V294458.R01.S.doc Version 5.1 Page 21 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. 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 the service. There are sufficient numbers of suitably qualified and experienced staff to meet the needs of Service Users. The home operates a robust recruitment system, which ensures all relevant security checks are put in place prior to a start date, ensuring the protection of Service Users. The home provides on going training and supervision to ensure the professional development of Staff thus ensuring the needs of Service Users is met. EVIDENCE: There has been no further recruitment of staff since the last inspection; therefore the inspector did not need to further assess this standard. All previous recruitment files are held securely in lockable facilities and have been assessed as meeting the standard. There are sufficient numbers of trained Nurses and Carers to maintain the home, feedback from Service Users was that the staff are very busy and there is always the need for additional staff to support them, however the home is
DS0000019193.V294458.R01.S.doc Version 5.1 Page 22 already providing additional hours above their required numbers which has been built into the staff budget. Flexibility within the rotas is evident to ensure the needs of Service Users can be met on any given day. The comment cards received as part of this inspection were generally complimentary of the staff team and the support offered, any issues arising from comment cards was fedback to the Manager in a manner that protects the anonymity of the individual. Staff have received ongoing training, which is planned to support them to meet the needs of the current Service User group. All mandatory training is up-todate with the records held on the training matrix reflective of when up-date sessions are due for individual staff. All training is planned on an annual matrix, which identifies which staff have attended training, when this was undertaken and when future training for the individual has been planned. Additional training opportunities that arise throughout the year are added to this matrix. The Manager is sharing the responsibility for the upkeep of this system with a suitably trained HCA (health care assistant) this has contributed to its success and has ensured training that is suitable to the needs of staff is identified and sourced. Training that has taken place this year includes, moving and handling, first aid, fire, wound care, diabetes awareness, POVA, food hygiene, infection control, constipation, dementia, oral care, foot care and visual impairment. Future planned and booked training includes palliative care, wound care, wound management, Parkinson’s, customer care and fire. Staff spoken with were complimentary of the Managers proactive approach to ensuring staff receive a variety of training, improvements in the training system has enabled them to put forward ideas or interests they may have which will further aid their professional development. Staff conveyed a motivation to improving on their practice and how they implement their duties. This was further evidenced when speaking with Service Users who were complimentary of the way in which staff approach their duties and the friendly and professional manner in which they support them. In discussion with the Manager it was evident the motivation shown towards attending courses is not following through to the NVQ training offered, presently there are two staff working towards their level 2 and two staff working towards their level 3 in NVQ, in addition there are 3 NVQ assessors working in the home. The Manager is exploring ways to motivate staff to take up the offer of NVQ training and will be speaking to staff to try and resolve this issue. The Inspector is confident the Manager is working towards resolving this and leaves it in her capable hands. A programme of supervision is in place for all staff with the Manager ensuring a minimum of six supervisions takes place annually. A supervision form is in place, which is used to record discussions and issues of concern. Any general
DS0000019193.V294458.R01.S.doc Version 5.1 Page 23 information or themes that is ascertained through supervision is then discussed within the staff team meeting this includes the outcomes of the last inspection report to ensure all staff are aware of improvement that need to be made and achievements. DS0000019193.V294458.R01.S.doc Version 5.1 Page 24 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37, 38. Quality in this outcome area is good; this judgement has been made using available evidence including a visit to the service. A suitably qualified and experienced manager who ensures the home is run in the best interest of Service Users manages the home. Staff are supported to meet the needs of Service Users with a full programme of training and supervision in place. The home ensures it follows current health and safety guidance to provide a safe and pleasant home for Service Users. EVIDENCE: A suitably qualified and experienced manager manages the home. General feedback received prior and during this inspection is of an approachable
DS0000019193.V294458.R01.S.doc Version 5.1 Page 25 Manager who will listen to concerns and suggestions for improvement. Staff believe she has been a motivating force behind training and implementing change for the home. The Manager reported feeling supported by the Proprietors to achieve the goals for the home and explore new initiatives that will further improve the quality of service provision. The home is working hard to improve on their current quality assurance systems, quarterly and monthly audits are taking place for such things as care systems, Careplans, Maintenance and Health and Safety as well as daily checks on such things as fire procedures. Satisfaction surveys are sent to Service Users and relatives to gain their views and build on the systems in place. It is recommended the Manager meet with the Proprietors and Manager of the other homes registered with the Organisation to develop the systems for Quality Audit for the Organisation. Further assessment of the Quality Audit systems will take place during future inspections. The home doesn’t maintain the finances of Service Users, preferring families to act on behalf of Service Users where necessary. The home is presently using an invoicing system for such things as hairdressing, newspapers and personal purchases made on behalf of Service Users. Policies and procedures, which are reflective of review, are in place, the home is currently updating their POVA, Clinical Procedures, Code of Conduct and Pressure Relief policies, some of these have been completed and will soon be introduced in the home. In addition as mentioned the home are further developing their annual development plan for Quality Assurance. Health and Safety systems are in place, which ensure the protection of service users, throughout the inspection good practice was observed by Carers, Nurses and Domestic staff. As mentioned in the environmental standards health and safety signage is used throughout the home and all items of C.O.S.H.H. are locked away when not in use. Staff have a clear understanding of their personal responsibilities towards the maintenance of health and safety in the work place and are following risk assessments and general guidance. All fire procedures are in place, with regular drills and testing of equipment taking place. The last fire authority report was open to inspection with no outstanding recommendations. A requirement has been made to ensure the self closing devises that are not working efficiently are repaired as soon as is reasonably practicable. This was already being actioned by the home and should be resolved soon. As the issue of concern with these mechanisms has not been caused by the homes inaction the home has maintained a rating of met (3) for this standard. DS0000019193.V294458.R01.S.doc Version 5.1 Page 26 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X 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 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X 3 3 DS0000019193.V294458.R01.S.doc Version 5.1 Page 27 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 OP38 Regulation 13 (4) c Requirement Faulty self-closing devises fitted to doors throughout the home are to be repaired as soon as is reasonably practicable to ensure doors are closing efficiently. Timescale for action 20/08/06 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 OP19 Good Practice Recommendations It is recommended locks to bathrooms and toilets are changed to locks that can be operated from the outside in the case of an emergency. It is recommended locks be fitted to the sluice room doors to ensure the ongoing safety and protection of service users It is recommended the Manager meet with the Proprietors and Manager of the other homes registered with the Organisation to develop the systems for Quality Audit for the Organisation. 2 OP19 3 OP33 DS0000019193.V294458.R01.S.doc Version 5.1 Page 28 Commission for Social Care Inspection Aylesbury Area Office Cambridge House 8 Bell Business Park Smeaton Close Aylesbury HP19 8JR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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