CARE HOMES FOR OLDER PEOPLE
Cherrytrees @ Abbotsbury Pettiver Crescent Hillmorton Rugby CV21 4JD Lead Inspector
Lesley Beadsworth Key Unannounced Inspection 11th January 2008 05:00 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 Cherrytrees @ Abbotsbury DS0000029373.V358943.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. Cherrytrees @ Abbotsbury DS0000029373.V358943.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Cherrytrees @ Abbotsbury Address Pettiver Crescent Hillmorton Rugby CV21 4JD 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) 01788 540163 01788 540163 Pinnacle Care Ltd Care Home 2 Category(ies) of Dementia - over 65 years of age (2) registration, with number of places Cherrytrees @ Abbotsbury DS0000029373.V358943.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Mrs P Hanlon is to achieve the NVQ award in Health and Social Care at Level 4 by 1st September 2006. 18th May 2006 Date of last inspection Brief Description of the Service: Cherrytrees at Abbotsbury provides respite care and day care facilities and services for people over the age of 65 years who have been diagnosed as having dementia. The service is provided on the ground floor, at the rear of an existing local authority residential care home, with its own entrance and reception area. The home provides two single bedrooms with en-suite facilities; there is additional space, which includes a communal lounge, dining area and kitchenette, and a small laundry. The home also offers up to eight places each day for older people assessed as requiring day care services, the day care provision is not subject to regulation procedures and therefore not registered with the Commission. The accommodation is light and airy, and has a range of equipment and adaptations for service users who have physical disabilities. Access is available to a landscaped enclosed garden at the rear of the building. Cherrytrees @ Abbotsbury DS0000029373.V358943.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes.
The inspection included a visit to Cherry Trees @ Abbotsbury. As part of the inspection process the registered manager of the home was sent an Annual Quality Assurance Assessment (AQAA), which is a self-assessment and a dataset that is filled in once a year by all providers. It informs us about how providers are meeting outcomes for people using their service. Information from previous reports, a completed survey returned to us and any other information received about the home has been used in assessing actions taken by the home to meet the care standards. Three residents were ‘case tracked’. This involves establishing an individual’s experience of living in the care home by meeting or observing them, talking to their families (where possible) about their experiences, looking at resident’s care files and focusing on outcomes. Additional records were viewed where issues relating to a resident’s care needed to be confirmed. Other records examined during this inspection included, staff recruitment, training, social activities, staff duty rotas, health and safety and medication records. The inspection process also consisted of a review of policies and procedures, discussions with the manager, staff, visitors and residents. The inspection visit took place between 5pm and 10pm. What the service does well:
The home offers comfortable and attractive surroundings that are clean, safe and generally odour free, Both residents were well groomed and looked well cared for. There was very good interaction between the manager and the two residents currently staying at the home. The manager was responding to residents needs sensitively and was able to describe how the staff attended to their needs. Conversations between them were respectful whilst including a little jovial banter. Equipment and adaptations in the home for use by residents included handrails, a raised toilet seat and a bath hoist. A visitor was able to confirm through conversation and in a survey returned to us that their relative’s personal and health care needs were being met.
Cherrytrees @ Abbotsbury DS0000029373.V358943.R01.S.doc Version 5.2 Page 6 Only the person in charge of the shift and who has undertaken appropriate training administers the medication. information about forthcoming events including contracted entertainers, Reminiscence, an organist, Fizzical Fun (movement to music), and PET (pet therapy). Visits are also made to other homes to attend musical shows there. A menu, offering a good selection and choice, is on display in the lounge area. A relative said in a survey, “My (relative) has been complimentary about the meals.... I have seen (relative) enjoy snacks outside of meal times” “My (relative) has not said anything negative about them and would have!!!)” Mandatory training for staff such as moving and handling, fire prevention, food hygiene, and first aid had taken place, giving staff the knowledge and skills to maintain a safe environment for the people living and working at the home. When asked if they knew who to speak to if they were not happy a relative said, “I have found staff friendly and approachable. If I was not happy I would not hesitate in talking to a member of staff.” Three staff files were looked at. These showed that all recruitment practices safeguard residents from the employment of unsuitable people with the appropriate checks having taken place. Whilst the people staying at he home at the time of the visit were unable to fully express their opinion of the services provided, observations made showed that they were well groomed, looked well cared for and showed signs of wellbeing. There was very good interaction between the manager and the two residents currently staying at the home. The manager was responding to residents needs sensitively and was able to describe how the staff attended to their needs. One relative commented, “I have been extremely impressed with the level of care my (relative) has received”. “I have witnessed excellent interaction. Residents were cared for in a respectful manner ensuring that their dignity and self-esteem were maintained. What has improved since the last inspection?
Cherrytrees @ Abbotsbury DS0000029373.V358943.R01.S.doc Version 5.2 Page 7 The home has a Quality Assurance system implemented by the organisation although the manager had not had the opportunity to focus on this due to the very short time she had been at the home. Progress had been made in providing staff supervision. This is necessary as it allows the management to meet with staff on a one to one basis to discuss practice, personal development and philosophy of the home issues. It is also an opportunity for staff to contribute to the way that the service is delivered. Care files included basic details of the person, to use in the event of, for example, emergency admission to hospital. What they could do better:
The lack of pre admission assessments mean that the home is not able to show that it can meet the needs of the prospective resident and of their needs being met. Care plans did not indicate that the care needs were based on an up to date assessment prior to the person coming to stay at the home. Care plans did not clearly explain the care required to meet specific needs. This has the potential for needs not to be met. Risk assessments had not been completed for pressure sores, moving and handling or for any individual risk. There is therefore the potential that action will not be taken to minimise the risks in these areas. There were no nutritional assessments or screening carried out on admission and therefore there was a risk that the residents’ nutritional needs would not be met. There were some concerns related to medication. • There is a risk of errors being made whilst administering medication as it is take from one area of the home to another and without means of making it secure in the case of an emergency. • The locked drawer where medication is kept could be easily accessed by unauthorised persons. • In a few cases Medication Administration Records sheets (MARS) were signed in pencil and the signature boxes had some unexplained gaps. An audit carried out with one person’s medication showed errors in the number of tablets that were remaining against how many should have been there.
Cherrytrees @ Abbotsbury DS0000029373.V358943.R01.S.doc Version 5.2 Page 8 These shortfalls create a potential risk to the health and welfare of the people staying at the home. There are shortfalls in infection control in the home mainly due to the lack of appropriate facilities for hand washing. Paper towels and soap dispensers need to be provided if fabric towels are not changed after each use. Dishes are washed by hand but in order to prevent accidental scalding to a service user the water is not hot enough to disinfect them. Advice should be sought from Environmental Health with regard to whether the current practice is satisfactory. Consideration should be given to providing a dishwasher, which would also free staff from the time taken to wash dishes. In order to ensure that the needs of residents are met at all times, and for reasons of safety, consideration must be given to the appropriateness of a member of staff working alone in the home. The home does not have a fax machine, although is able to scan documents an e-mail then as required. The home should have a manager who has been registered with us through the fit person process. The filing cabinet was faulty and if documents stored there are to be secure should be replaced. As it takes a great deal of effort to open the drawers it is also a safety risk. The padlock and hasps used to secure a drawer in each of the bedrooms should be replaced for something less unsightly. It does not provide the security required for medication. 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. Cherrytrees @ Abbotsbury DS0000029373.V358943.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 Cherrytrees @ Abbotsbury DS0000029373.V358943.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): 3 Quality in this outcome area is adequate. Information required to make a decision about choice of home is not available when needed. Pre-admission assessments are not up to date to confirm if the needs of prospective residents can be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Both care files of the two residents currently at Cherry Trees were looked at. One had previously been at another home in the organisation and the other was a regular day care service user. Assessments had been carried out for both of these residents by the other services. These were in reasonable detail and covered the areas required for assessing a person’s needs. However no further pre admission assessments had been carried regarding their needs in relation to Cherry Trees. In order to have up to date information a pre admission assessment needs to be carried out prior to any decision being made about whether the home is able to meet those needs. Failure to do so runs the risk of needs not being met in a person centred way and in relation to
Cherrytrees @ Abbotsbury DS0000029373.V358943.R01.S.doc Version 5.2 Page 11 the home’s environment. This is particularly the case for someone who has only previously been a day care service user as needs either side of the day care hours would not have been necessarily assessed. The outcome of such an assessment needs to be sent in writing by the home to the person assessed. The manager, who had only been at the home for four weeks, was able to discuss her plans for future pre admission assessments and had begun to prepare these for people coming to Cherry Trees for respite in the near future. Cherrytrees @ Abbotsbury DS0000029373.V358943.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 adequate. There are shortfalls in care plans that carry the risk of residents’ needs not being met and in maintaining confidentiality. Residents have access to health care professionals and are cared for in a respectful manner. There are some concerns around the medication process that could mean risks to residents’ well being. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Both residents were case tracked. Care plans were in place for both residents who were staying at the home on a short-term basis for respire care. Care files included basic personal details of the person, to use in the event of, for example emergency admission to hospital. The care plans did not indicate that the care needs were based on an up to date needs assessment, carried out prior to the resident moving into the home. Both care plans included all appropriate headings apart from specifically
Cherrytrees @ Abbotsbury DS0000029373.V358943.R01.S.doc Version 5.2 Page 13 for hearing and vision, which were included in the communication section. Whilst these clearly explained what the needs that had been identified, they did not clearly explain the care required to meet that need. For example in the section related to communication it said “can forget what staff have asked and then talks about something else”, but not how staff should be managing this. This has the potential for needs not to be met. Risk assessments had not been completed for pressure sores, moving and handling or for any individual risk. There is therefore the potential that action will not be taken to minimise the risks in these areas. There were no nutritional assessments or screening carried out on admission and therefore there was a risk that the residents’ nutritional needs would not be met. As the residents at Cherry Trees are only staying there for a short time there was no evidence of routine access to health care services. However details of the GP of the resident were available for if required and the organisation has access to health services should they be required during the person’s stay. The two current residents at the home for respite care were unable to fully express their opinion of the services provided. Time was spent in the lounge observing care delivery and staff/resident interaction. Both residents were well groomed and looked well cared for, showing signs of well-being. There was very good interaction between the manager and the two residents currently staying at the home. The manager was responding to residents needs sensitively and was able to describe how the staff attended to their needs. A visitor was able to confirm through conversation and in a survey returned to us that their relative’s personal and health care needs were being met and commented, “I have been extremely impressed with the level of care my (relative) has received”. “I have witnessed excellent interaction”. Equipment and adaptations in the home for use by residents included handrails, a raised toilet seat and an assisted bath. Medication was kept in individual bedrooms in a locked drawer although this was not totally secure and the padlock and hasp used was ugly and institutional looking. A policy for medication was available and only designated and trained staff allowed to administer medication. The administration procedure consisted of the responsible member of staff collecting the medication from the bedroom, taking it to the relevant resident and then returning to the bedroom to sign the Medication Administration Record Sheets. Although there were only two
Cherrytrees @ Abbotsbury DS0000029373.V358943.R01.S.doc Version 5.2 Page 14 residents to administer medication to there is a risk that the member of staff could be distracted whilst taking the medication or be called to an emergency, especially as they would possibly be the only person available. This creates the risk of errors being made in the administration, security and/or recording of medication and therefore not safeguarding the health and welfare of the residents. In one or two cases Medication Administration Records sheets (MARS) were signed in pencil and the signature boxes had some unexplained gaps. An audit carried out with one person’s medication showed errors in the number of tablets that were remaining against how many should have been there. These shortfalls create a potential risk to the health and welfare of the people staying at the home. Residents were cared for in a respectful manner ensuring that their dignity and self-esteem were maintained. Cherrytrees @ Abbotsbury DS0000029373.V358943.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. Residents were occupied and stimulated. Visitors were made welcome and their needs considered. Residents had choices and control over their daily lives. Residents enjoyed the nutritious and varied meals provided. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Notices were displayed in the home to inform residents and day care service users of the wide range of activity and occupation offered, including information about forthcoming events including contracted entertainers, Reminiscence, an organist, Fizzical Fun (movement to music), and PET (pet therapy). Visits are also made to other homes to attend musical shows there. The manager advised that service users choose what they want to do each day. There were examples of craftwork made by service users displayed in the home. on the evening of the visit the manager spent time chatting with the residents and music was being played. Residents were asked if they were happy with the music. The two residents were able to walk about the home
Cherrytrees @ Abbotsbury DS0000029373.V358943.R01.S.doc Version 5.2 Page 16 and spend time wherever they wished. Board games and other activity items were readily available. Whilst there was a television in the lounge area this was not turned on as the manager said that the current residents had shown no interest. Visiting is at any time but the manager said that there were infrequent visitors due to the respite aspect of the service. One person visited during the visit and spoke positively of the home, saying that the staff were always welcoming. Whilst residents were unable to confirm that they had choices and control over their daily lives, observations made and discussion with the manager and a relative showed this. the manager said that if a resident wanted to leave the building they would not be stopped from doing so and a member of staff would accompany them, though this would be difficult outside of day care service hours when there may only be one person on duty. There is a choice of meals and the choice of partaking in the activities or not and no restrictions were seen to be put on residents during the visit. A relative commented in the survey, “There has always been well informed staff on duty who encourage my (relative) to maintain independence whilst being supportive.” There is a good sized, homely dining area adjacent to the living room with a kitchenette for making snacks and the breakfast and teatime meals. Dishes were washed by hand but as residents have access to the sink the water is not hot enough to disinfect them. A dishwasher should be considered. This would also free staff from the time spent washing dishes that needs to be spent with residents. . Advice should be sought from Environmental Health with regard to whether the current practice is satisfactory. A menu, offering a good selection and choice, is on display in the lounge area. The main meal of the day is provided by the adjoining Local Authority care home at lunchtime and is brought in a heated trolley through a link door. A relative said in a survey, “My (relative) has been complimentary about the meals.... I have seen *** enjoy snacks outside of meal times” “My (relative) has not said anything negative about them and would have!!!)” The member of staff on duty makes breakfast and tea. At the time of the visit sandwiches were given to the residents who were happy with these, and the next member of staff to come on duty was to make a more substantial meal. However it is difficult to see how there would be time and opportunity to do this when there is only one member of staff in the home, particularly if there
Cherrytrees @ Abbotsbury DS0000029373.V358943.R01.S.doc Version 5.2 Page 17 were two residents who both needed close supervision or had a high degree of care needs. Cherrytrees @ Abbotsbury DS0000029373.V358943.R01.S.doc Version 5.2 Page 18 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. The home has appropriate policies and procedures to safeguard residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There was a complaints procedure on display in the reception area. The home had complaints records but the manager advised that there had been no complaints made. There was a selection of thank you cards showing that people had been grateful for the service provided. When asked if they knew who to speak to if they were not happy a relative said, “I have found staff friendly and approachable. If I was not happy I would not hesitate in talking to a member of staff.” Residents spoken with at the time of the visit had limited understanding and were unable to give their views. The manager had undertaken training related to protection of vulnerable adults to give her the knowledge and skills required to identify abuse and to safeguard residents from abuse. She and other staff are due for refresher training in this subject. A relevant policy was also in place.
Cherrytrees @ Abbotsbury DS0000029373.V358943.R01.S.doc Version 5.2 Page 19 Recruitment practices safeguard residents from the employment of unsuitable people. Cherrytrees @ Abbotsbury DS0000029373.V358943.R01.S.doc Version 5.2 Page 20 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,24,26 Quality in this outcome area is good. The home offers the people living there comfortable surroundings, which are clean, free of offensive odour and generally safe and well maintained but with some shortfalls. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service is provided on one level and adjoins the rear of an existing local authority residential care home. It has its own entrance and reception area but is connected by a link door. This was locked at the time of the visit. The reception area is quite impersonal with notices to staff, visitors and service users, and an assisted toilet. a visitors book was available. The office is at the far end of this area. The office is very tiny, barely housing the equipment/furniture required and not suitable for the manager to meet with visitors or people from other agencies. The home does not have a fax machine although the manager said that documents could be scanned and then eCherrytrees @ Abbotsbury DS0000029373.V358943.R01.S.doc Version 5.2 Page 21 mailed. The filing cabinet storing confidential documents was faulty and unable to be locked/unlocked without considerable effort, creating a health and safety and security risk. This needs to be replaced. The home has a large, bright lounge that is furnished in a homely and comfortable manner. There is an adjoining dining area and kitchenette. There was a faint odour of urine in one part of the lounge, which the manager said had recently occurred, and it was being dealt with. The rest of the home was free from any offensive odour. There are two bedrooms, both of similar size and attractively decorated and carpeted and appropriately furnished and with ensuite facilities. They were clean and free of odour. However they were spoiled by the ugly padlock and hasp on a set of drawers in each room. This was meant to create a safe space for the occupant of the room but which apart from looking institutional did not provide the security required for medication. There is an assisted bathroom/toilet that was clean, bright and welcoming, and a further toilet with wash hand basin. The organisation has avoided using soap dispensers and disposable towels because of the clinical/institutional appearance. Whilst there were ample fabric towels stored in the bathroom their use is only acceptable if changed after each use. Any less than this creates a high risk of cross infection and/or contamination. It is unrealistic to expect this to happen, especially when there is only one member of staff. Paper towels in a suitable dispenser and soap dispensers must be available in communal areas where staff and residents would be expected to wash their hands. Laundry facilities were inspected and found to be well organised, clean and hygienic. Washing machines had the appropriate programmes to enable the disinfecting or sluicing of laundry as required. Cherrytrees @ Abbotsbury DS0000029373.V358943.R01.S.doc Version 5.2 Page 22 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is adequate. There are sufficient care staff available to meet the needs of the residents but a lone worker may have an impact on this. Satisfactory recruitment practice protects residents from the employment of unsuitable people. The importance of training is recognised. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the time of the visit the manager was the only member of staff on duty and was waiting for the care assistant covering the evening shift to take over from her. Rotas looked at showed that there was only ever one member of staff on duty outside of the day care service hours, including the night shift. The manager advised that they work to one member of staff to five service users but more staff would be ‘brought in’ if there was a need. The home has a ‘lone worker’ policy, which involves the member of staff phoning another home every hour, and if they do not do so that home contacts them to make sure all is well. This happened during the visit when, possibly due to the process of the inspection, the member of staff had failed to make the hourly call. The designated home rang her to check that there was not a problem. The two service users present during the visit were disorientated in time and suffered severe memory loss. Both required almost constant supervision to ensure their safety and time and attention to keep them suitably occupied. One of the service users needed regular reassurance about why they were at
Cherrytrees @ Abbotsbury DS0000029373.V358943.R01.S.doc Version 5.2 Page 23 Cherry Trees and when they were going home. Whilst there was no evidence to suggest otherwise, in order to ensure that the current residents’ needs were not being met at all times, and for reasons of safety, consideration must be given to the appropriateness of a member of staff working alone in the home. The home has not yet achieved 50 of their staff having National Vocational Qualification (NVQ) Level 2 in Care but with two staff having this qualification and three staff currently undertaking the training they are on target to do so. This qualification shows that staff have been assessed as competent to carry out their role. Other training undertaken by staff at the home included induction and that related to dementia, health and safety, fire awareness, food hygiene, first aid, moving and handling (how to transfer people safely), medication and infection control. Further training related to infection control, mental health awareness, Parkinson’s Disease, Stroke Awareness and Palliative care awareness. Three staff files were looked at. These showed that all recruitment practices safeguard residents from the employment of unsuitable people with the appropriate checks having taken place. A handover between the manager and the night care assistant took place at the end of the visit. Duty rotas viewed for the home showed that there is no staff handover period built into the shift times. The organisation therefore relies on the good will of staff to stay over their shift time and/or to come in early to share information about residents’ needs or events. Cherrytrees @ Abbotsbury DS0000029373.V358943.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,38 Quality in this outcome area is adequate. A person undertaking the appropriate qualification and who has previous management experience manages the home. There are shortfalls in the security of records that create a risk to confidentiality. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager had only been at the for four weeks having transferred from another home within the organisation, where she held a senior position and had therefore had appropriate experience. She was undertaking the Registered Managers Award to enable her to be suitably qualified and estimated that this would be completed in three months. She had not yet applied to us to be the registered manager of the home.
Cherrytrees @ Abbotsbury DS0000029373.V358943.R01.S.doc Version 5.2 Page 25 The manager showed enthusiasm for her new role and had managed to acquire an awareness of the service in the short time that she had worked there. Whilst she was the only member of staff available for most of the visit there was an opportunity to briefly meet the member of staff taking over from her who said that she had already been supported by the manager. The night staff also arrived at the end of the visit. There was an easy rapport between the manager and the staff. The organisation’s Quality Assurance programme was in place at the home although the manager had had little opportunity to focus on it in her short time at the home. Unannounced monthly visits are made to the home by a representative of the organisation in order to audit the service provided. A report is written and copies sent to the home manager and to us. The manager advised that systems had been set up for care staff to have formal supervision six times a year but had not yet had the opportunity to supervise all staff by the time of the visit. Staff supervision allows the management to meet with staff on a one to one basis to discuss practice, personal development and philosophy of the home issues. It is also an opportunity for staff to contribute to the way that the service is delivered. No money was held by the home on behalf of residents. The manager said that there was little need for them to have money during the time they were there but if they wanted any purchase, such as newspapers, their family would be asked for the money. Concerns regarding health and safety have been discussed in the report. These were the filing cabinet in the office being unsafe and the concerns regarding members of staff working alone. A random inspection of maintenance, service and health and safety checks was made and these were in good order. Mandatory training for staff such as moving and handling, fire prevention, food hygiene, and first aid had taken place. Cherrytrees @ Abbotsbury DS0000029373.V358943.R01.S.doc Version 5.2 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 3 X X 3 X 2 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 2 X 3 x 3 x x 2 Cherrytrees @ Abbotsbury DS0000029373.V358943.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14 Requirement All people staying at the home must have an up to date preadmission assessment carried out and recorded. This will ensure that the home is able to meet their needs. All people staying at the home must have an up to date and detailed care plan that describes the care needed to be provided. This will ensure that they receive person centred support that meets their needs. Risk assessments should be carried out for each person staying at the home related to the incidence of pressure sores, moving and handling and nutritional needs. Medication must be stored securely. This will safeguard the well being of the people staying at the home. When medication is administered clear, permanent and accurate records must be maintained. This will ensure that people staying at the home receive the correct medication.
DS0000029373.V358943.R01.S.doc Timescale for action 29/02/08 2. OP7 15 29/02/08 3. OP8 14 29/02/08 4. OP9 13 15/02/08 5. OP9 13 15/02/08 Cherrytrees @ Abbotsbury Version 5.2 Page 28 6. OP9 13 7. OP26 13(3)(4) Medication must be administered as instructed by the GP and according to the Medication Administration Record Sheets. This will ensure that people staying at the home receive the correct medication at the correct time. Paper towels must be available in a suitable dispenser in communal areas where staff or residents would be expected to wash their hands. This would improve infection control. (Outstanding from inspection dated 23/09/05) Monitoring of the number of staff on duty outside of day care hours and the suitability of the lone worker practice must take place. This will ensure that the needs of the residents are met and safeguard their well being. 15/02/08 29/02/08 8. OP27 18(1) 15/02/08 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. 3. Refer to Standard OP19 OP19 OP28 Good Practice Recommendations The faulty filing cabinet in the office should be replaced. Consideration should be given to improving the office facilities, including the provision of a fax machine. The registered provider must confirm to the Commission the plans for ensuring that a minimum of 50 of care staff are qualified to NVQ level 2. Cherrytrees @ Abbotsbury DS0000029373.V358943.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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
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