Inspection on 10/01/07 for Cheverells

This inspection was carried out on 10th January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Cheverells 20/11/07

Cheverells 09/12/05

Cheverells 12/05/05

Cheverells 23/11/04

Cheverells 14/06/04

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

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

CARE HOMES FOR OLDER PEOPLE Cheverells Limers Lane Northam Bideford Devon EX39 2RG Lead Inspector Victoria Stewart Key Unannounced Inspection 10th January 2007 10:15 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 Cheverells DS0000022173.V315517.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. Cheverells DS0000022173.V315517.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cheverells Address Limers Lane Northam Bideford Devon EX39 2RG 01237 472783 NO FAX 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 Philip Woods Mrs Gaynor Woods Care Home 36 Category(ies) of Mental Disorder, excluding learning disability or registration, with number dementia - over 65 years of age (36), Old age, of places not falling within any other category (36), Physical disability over 65 years of age (36) Cheverells DS0000022173.V315517.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th December 2005 Brief Description of the Service: Cheverells Care Home is registered to provide personal care for up to 36 men or women over the age of 65 years, some of whom may have a physical disability or mental health disorder. Cheverells is a large detached Victorian property with several purpose built extensions, situated just outside Bideford, with views across the River Torridge. The bedrooms are spacious, light and individually sized. With the exception of one room, all have en-suite facilities. Decoration and furnishings throughout the home are of a high standard. Communal areas are also spacious and include three sitting rooms, a dining room and a sun lounge. Externally the home is well maintained and sound. The garden is mature and beautifully kept; there is a pond with wild mallard ducks and a wooded area. An attractive chrome barrier surrounds the pond. The garden is accessible for residents to enjoy with several stair lifts giving access to all areas of the home. A ramped entrance has been built to further increase access to the home. The cost of care ranges from £274 to £360 per week depending on individual needs. Additional costs, not covered in the fees, include chiropody, hairdressing, and personal items such as toiletries and newspapers. Current information about the service, including CSCI reports, is available to prospective residents, relatives and others who may have an interest such as care managers. Cheverells DS0000022173.V315517.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 10 January 2007 over a period of 9 hours. The home had been notified that an inspection would take place within three months and had returned a pre-inspection questionnaire, information from which has been used to write this report. Many residents contributed to the inspection on the day, as did the owners, assistant manager, staff and visitors. The CSCI Pharmacist Inspector also visited the home on 23 February 2007 and completed a separate report to this one relating to the medication practice in the home. His findings are incorporated into this report. There were 32 residents living at the Cheverells on the day of inspection and the inspector spoke or saw with all of the residents, either in the communal areas or in their private rooms. Seven residents were spoken with in depth, the inspector shared lunch with three other residents and chatted with six other residents in one of the sitting rooms, along with three relatives. Prior to the inspection a number of CSCI information questionnaires were sent out by post to residents, relatives, health and social care professionals and care staff who work at the home. This was to gain their views on what it is like to live at the Cheverells. Many comments made are included within this report. 7 out of 15 of these questionnaires sent to residents were returned, 8 out of 19 from staff were returned, 3 out of 4 from health or social care professionals were returned and 2 out of 4 from relatives were returned. All of these surveys were very positive about the care given at Cheverells. This report is written using other evidence gained - this included a full tour of the building and by looking at a selection of records, which included care records, staff records, medication records, health and safety records and quality assurance records. What the service does well: Cheverells provides good quality care for residents who live there. Prospective residents are encouraged to visit the home before they move in, to make sure it is the right place for them. Residents are encouraged to make their lives as independent as possible. All residents spoken with praised the care they received from the staff and said they were very happy living at the home. A unanimous “We love it here!” was a comment from many residents. Residents’ health and medical needs are met by good working relationships with other professionals. Staff pay very high attention to the privacy and dignity of all the residents at the home. Residents enjoy the home cooked food served and enjoy taking part in organised activities, especially the weekly minibus trip. Cheverells DS0000022173.V315517.R01.S.doc Version 5.2 Page 6 The home is extremely well maintained, warm and homely with residents enjoying private rooms filled full of their personal and sentimental possessions. The home has a friendly and welcoming atmosphere and residents feel that they are listened to if they have a concern. Staff are well trained and look after for residents in a kind and caring way. There are enough staff on duty to make sure that the needs of residents can be met. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Cheverells DS0000022173.V315517.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cheverells DS0000022173.V315517.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 5 & 6 Quality in this outcome area is good overall. This judgement has been made using available evidence including a visit to this service. There are good arrangements in place to ensure that prospective residents or their representatives visit the home and spend some time there to see whether it will meet their needs The admission and assessment process to the home is good but improvements to record keeping will ensure that all the staff are fully aware of residents needs on admission. The home does not provide intermediate care. EVIDENCE: The care files of three residents at the home were looked at, including two residents who had recently come to live at the home. The assessment documents (which are completed before a resident moves into the home) proved difficult to find, as they were not held with the residents’ care files. However, when they were found two of the files showed that the residents had Cheverells DS0000022173.V315517.R01.S.doc Version 5.2 Page 9 their care needs assessed prior to them moving into the home. They had been carried out by a representative of Devon County Council Social Services. These records contained comprehensive and detailed information to assess whether individual health, social and welfare needs could be met by the home. The remaining file of a resident who was privately funded did not contain an assessment. The owner and deputy manager explained the admission procedure, which includes visiting the prospective resident at home, hospital or another establishment. However, both said that the home does not currently record this information formally and therefore this information is not written down anywhere. The deputy manager told the inspector that she is currently working on a suitable document for the home to use. Resident and relative surveys confirmed that they are both invited to visit the home prior to choosing to live there and one resident said “…visited me in my home and gave all the information” and “we were invited to visit the home at any time without appointment”. All staff questionnaires said that they were never asked to care for people who they did not feel experienced enough to look after. The home does not provide intermediate care services. Cheverells DS0000022173.V315517.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good overall. This judgement has been made using available evidence including a visit to this service. Residents benefit from a kind and caring staff group, that treat them with respect, privacy and dignity at all times. The systems in place for the administration of medicines is adequate but systems need further improvement to prevent putting residents at unnecessary risk of harm. There is good evidence to show that specialist advice from health and social care professionals is followed by staff, which helps to contribute to the well being of residents There have been some improvements in the care planning process. Further development of these plans and other care records will continue to ensure that all residents’ health and personal care needs are met in a consistent manner by care staff. EVIDENCE: Cheverells DS0000022173.V315517.R01.S.doc Version 5.2 Page 11 All returned residents’ questionnaires confirmed that they “always” or “usually” receive the care and medical support they need. One comment was “the care given by all the staff is of the highest and given willingly”. Both of the returned relative questionnaires said that they were satisfied with the overall care provided. Residents spoken with during the inspection said that they felt their care needs were fully met, with comments such as “ the carers are out of this world and will do anything for you”, “could not wish for better care and attention” and an overwhelming comment of “we like living here!” Residents’ medical needs are well met. One care professional visiting on the day of inspection was spoken with and three health or social care professional questionnaires were returned. All said that there was good communication and working between them and the home. One said that the home always telephones and asks for appropriate visits for a resident if required and gives them lots of feedback. One resident commented, “if you feel out of sorts Mrs Woods would ask you your symptoms and if she feels you require the attention of your doctor will have him visit and she will act on his instructions”. One resident told the inspector that the owners always accompany residents when they visit the GP, or the local hospital, for medical appointments by car. All resident questionnaires said that they felt they “always” received the medical support they needed. The care planning records and risk assessments of three residents were looked at. While the care records generally outlined the residents’ care needs and tasks to be performed by staff, it was felt that there was not enough information written about how staff should actually ‘care’ for the residents. For example, one resident had an incontinence need identified but the care plan did not demonstrate to staff how to meet this care need fully. Staff confirmed they relied on their own knowledge to do this. Also care files lacked any detailed information on a resident’s previous social history, occupations, interests and day-to-day living choices. Care files did contain some risk assessments in relation to mobility and moving and handling, but these would also benefit from more information being recorded on them. Three residents in the home have had bed-rails put in place to prevent them falling out of bed but this has not been appropriately risk-assessed and agreed with the residents or their representatives involved. The home is in the process of changing the care records/files and the inspector was shown how this was going to be done. When completed, these records should then furthur help staff to meet all the residents’ identified care needs in a consistent manner rather than relying on individual staff’s knowledge. Staff displayed a very good understanding of meeting the privacy and dignity needs of residents in their questionnaires and during the inspection. Residents confirmed that they felt they are always treated with respect. Relative and professional surveys confirmed that they could visit in private. Residents Cheverells DS0000022173.V315517.R01.S.doc Version 5.2 Page 12 spoken with confirmed that they were treated with privacy and dignity, for example by staff knocking on doors before entering and calling them by their chosen names. Staff were seen offering personal care and attention in a discreet manner. Staff/resident interaction was friendly, comfortable and easy which showed that residents felt at ease with staff. The medication procedures and records were looked at. All medication received into the home is recorded and signed for, with the exception of extra prescribed medications, for example antibiotics. This means that it is not possible to audit the medicines in the home. Medicines which are prescribed externally, for example creams, are not recorded to indicate that they have been applied which means the home does not know if the products are being used appropriately. Medication administration records (MAR) were generally satisfactorily completed with the exception of medications which had been hand written. These were not signed and dated for by the person making them and no reason given if the medication had been started or stopped – this increases the risk of error and an incorrect dosage given. One or two gaps on the MAR chart were noticed and the appropriate codes had not been used, which would identify why certain medications had not been given. Appropriate records were kept for controlled drugs and stock held correlated with totals recorded. A dedicated medicine fridge is used which is kept in a locked office. However, various members of staff including the cook, has access to this office, thus not making it secure. Routine temperature monitoring of the fridge is not carried out and this may mean that some medicines are not stored at the correct temperatures. Some medicines were removed from the fridge during the inspection, which do not require lower temperatures and may affect the way they work. Some staff have undertaken training in the administration of medication and other members of staff who dispense medication still require this. Most of the residents’ medication is removed from the MDS system, ‘potted up’ and then held in the office before the medicines are given. This practice is not considered safe. The home has some residents who look after their own medication. However, records to show risk assessments and the supply of these medications to residents are not reviewed. Since the last inspection, one complaint regarding medication has been received (refer NMS 16). Cheverells DS0000022173.V315517.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are encouraged by the home to maintain their independence and are able to exercise choice and control over their lives. The home offers a programme of social and recreational activities which residents enjoy and take part in. The meals in the home are good offering both choice and variety; residents’ personal tastes and choices are taken into consideration with special dietary needs catered for. EVIDENCE: Resident questionnaires confirmed that residents either “always” or “usually” like the food that is served. Comments included “it’s lovely” and “there’s plenty of food!” The inspector shared lunch with three residents who all enjoyed their meal. Whilst no formal choice of meal is offered at lunchtime, the cook knows the residents very well and those that do not like what is on the menu are offered an alternative. Some residents felt that a choice of lunchtime meal might be nice and this would give them some variety within the 4-weekly planned menu. One other resident said that he is offered an alternative on one day of the week when he does not like the meal served. The Cheverells DS0000022173.V315517.R01.S.doc Version 5.2 Page 14 home caters for different diets and provides a daily alternative vegetarian meal. One resident commented that the cook “will cook anything of your own when asked”. If a resident would like certain types of food, then the home will buy it in. A couple of residents commented that they did not particularly like the cottage pie served on a Saturday but no alternative is offered. One resident was asked what was for lunch and she said she did not know but “if it’s Wednesday, it’ll be lamb”. This was discussed with the owners who are keen to make sure that all residents are happy with the food provided. Fresh fruit is always freely and readily available for residents to snack between meals. Resident questionnaires stated that there were “always” or “usually” activities that they could participate in. The home does have an activities programme, which consists of bingo, musical movement, exercises, visiting entertainers and occasional quizzes. The highlight of the week is the Friday trip out when several residents go out in the minibus and visit attractions in the area, (sometimes with a accompanying cream tea), to places of interest such as the countryside, garden centres and the coast. Residents and their relatives confirmed in their questionnaires that they are made to feel welcome in the home at all times. A further three relatives visited during the inspection and together with the inspector and seven residents, had a very friendly, positive and lively discussion about how happy they were at the home. Residents confirmed that they have choice in their life styles and are able to come and go as they please and that they make their own choices at the home to spend the day as they please. One resident said, “we are as free as the air” and another “we can come and go as we please”. One resident told the inspector that she likes to have her breakfast at about 5 am and then go to bed at 3 pm and another resident told the inspector she was having a “lazy” day and spending the day in her room in her nightclothes. Residents have several communal areas in various parts of the home in which they can choose to sit, either on their own or with others, with or without noise, for example from televisions or radios. Cheverells DS0000022173.V315517.R01.S.doc Version 5.2 Page 15 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 overall. This judgement has been made using available evidence including a visit to this service. The home has a good complaints system with some evidence that residents and relatives feel their views are listened to and acted upon. Residents are protected from abuse from staff who recognise the principles of adult protection, but would benefit from receiving formal training on this. EVIDENCE: The home has an up to date complaints policy and currently records all complaints in a book. One complaint regarding a resident who had been given the wrong dosage of medication had been received in May 2006 and was investigated by the CSCI. The complaint was upheld and the CSCI required the home to review its medication practice to prevent residents being given the wrong medication again. None of the residents or relatives spoken with during the inspection had any concerns or complaints and all demonstrated in their questionnaires that they were fully aware of whom to complain to and felt comfortable and confident that any problems would be sorted out. Comments included “All the staff are very attentive and if you have any complaint it will be followed up and have Mrs Woods informed to take any action required” and “first talk to the carer and if you aren’t satisfied ask her to tell Mrs Woods”. Staff said in their questionnaires that they are aware of adult protection issues and staff working in the home demonstrated their awareness of what abuse Cheverells DS0000022173.V315517.R01.S.doc Version 5.2 Page 16 meant. However, training records confirmed that only three members of staff have currently attended any recognised formal training in the Protection of Vulnerable Adults. Staff were unsure about the correct procedures for reporting any suspected abuse and which other agencies to involve. Cheverells DS0000022173.V315517.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 25 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents enjoy living in a home that is always clean, homely and well furnished. EVIDENCE: The home is very well maintained, clean and attractive both inside and outside of the building. All resident questionnaires said that it was “always” fresh and clean. This was observed on the day of inspection. The home does not have a formal maintenance or refurbishment plan but the owners replace and repair items when they think they need it. Since the last inspection various updating in the home has been carried out to make it more attractive for residents to live in, for example new flooring, new curtains and new crockery/cutlery. 7 residents’ rooms were visited during the inspection and these were all well maintained. Three of these residents choose to spend most of the day in their rooms and are very happy with them. Some residents have favourite areas of the home and others move freely around. All private rooms are individual in Cheverells DS0000022173.V315517.R01.S.doc Version 5.2 Page 18 size, shape and décor and have been decorated in different ways. Residents’ rooms contain all sorts of personal, sentimental and private furniture or possessions, which make their private rooms very attractive and homely to be in. Residents can lock their rooms to keep them private. The home has several communal areas, which meets the needs of residents. The inspector felt the lighting was dim in a sitting area and saw that one resident appeared to be struggling to see properly to go down some stairs. Light bulbs were noted to need replacing in these communal areas and this was carried out when brought to the owner’s attention. Some chairs in the dining room also needed attention to make them safe for residents to use. The owner of the home currently does the maintenance but a new person is soon to be employed to take over this task. The home has a supply of protective clothing and hand-washing facilities, but one staff member felt this could be improved by having a stock of these in each areas of the home instead of one central area which would encourage staff to use them more routinely and prevent any unnecessary infection. The home has a satisfactory laundry area but this was seen to be freely accessible to everyone in the home and contained some items that could be potentially hazardous to both residents and visitors (refer NMS 38). Cheverells DS0000022173.V315517.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate overall. This judgement has been made using available evidence including a visit to this service. Staffing numbers throughout the day and night are sufficient to ensure that residents’ general care needs can be met. Staff receive the training necessary to allow them to do their jobs properly. The recruitment procedures for the employment of staff needs improving to ensure that residents living at the home are not potentially put at risk by only employing staff when all necessary checks have come through. EVIDENCE: On the day of inspection six care staff, one cook, one kitchen assistant, two cleaners, one laundry assistant and the deputy manager were on duty throughout the morning. The owners also came in to assist with the inspection. Staff giving care did so in an unhurried and relaxed manner. All resident questionnaires said that they felt that there was “always” enough staff on duty to care for them and that staff “always” listened and acted on what they said. Two staff questionnaires said that they would like more time to spend with residents to engage them in interests and activities. Currently 38 of the care staff have an NVQ 2 (formal training in care) or above, but this is shortly to be increased with more staff undertaking the NVQ learning. Cheverells DS0000022173.V315517.R01.S.doc Version 5.2 Page 20 All newly employed staff undergo a period of training and time when they ‘shadow’ a member of staff until they get to know the residents, the layout of the home and the safety and care procedures. Regular monthly training sessions are held for staff by an outside training agency which staff confirmed are useful for their care practice, for example dementia care and infection control. The pre-inspection questionnaire confirms that training in first-aid, communication, verbal skills, moving and handling, pressure sores, drug awareness and policies has taken place since the last inspection. The staff files of three recently employed staff were looked at. Whilst these files held some of the information required on each employee, the home had not received suitable references or a Protection of Vulnerable Adult (PoVA) check or Criminal Records Bureau (CRB) check for two of these staff members prior to them starting work at the home. This required immediate action and puts residents at risk of unnecessary potential harm. Cheverells DS0000022173.V315517.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37 & 38 Quality in this outcome area is adequate overall. This judgement has been made using available evidence including a visit to this service. Clarity in the management arrangements will furthur enhance the running of the home, which will benefit the residents and staff There is some evidence to suggest that residents’ views are sought in the running of the home but this could be improved upon. Improvements to some aspects of the management of health and safety will ensure that residents are fully protected from risk of harm Whilst the record keeping is generally satisfactory, some records need improving to prevent putting residents at risk of unnecessary harm. EVIDENCE: Cheverells DS0000022173.V315517.R01.S.doc Version 5.2 Page 22 The owners have run the home for approximately twenty years and are very experienced in working with older people. One of the owners has achieved the Registered Manager’s Award, which is a formal qualification in management. (RMA). The owners visit the home on a daily basis and oversee its running but the home has recently undergone some re-organisation. The assistant manager is currently undertaking an NVQ level 4 in care and also the RMA and she manages the home on a day-to-day basis. The owners provide support, advice and guidance as required. However, it was clear from staff surveys and by speaking to staff that the owners are still regarded as managing the home and would be approached by staff if any problems or complaints arose, bypassing the assistant manager. As the assistant manager is learning how to manage the home overall and is working towards becoming the registered manager of the home, it is unclear what her role actually is at present. Her role is not clearly defined thereby causing some confusion and unacceptance by some staff in the home. No senior staff are employed to take charge of the home in her absence and the keyworker system, which used to be in operation is not now being used. This meant that residents were unaware of which staff to ask if they need anything doing for them, for example personal shopping or help with tidying of their possessions. The organisation structure written in the pre inspection questionnaire does not reflect the actual management arrangements at the home. Residents, staff and relatives all confirmed their confidence with the owners in their questionnaires and said that they feel very well supported. Staff comments included: “Mr and Mrs Woods always have time for the residents and are very caring, putting their care before anything else”, “Mrs Woods makes everybody feel at home and this is a lovely home to work in” and “Mr and Mrs Woods are wonderful bosses”. Care staff, management and records confirmed that regular staff supervision does not take place and therefore the standard of work and formal training needs cannot be identified and discussed. The owners told the inspector that the home operates a twice-yearly quality audit from residents to influence the way in which the home is run. Notes from the one held in February 2006 were seen. No regular resident meetings are currently held where residents would be able to voice their opinions and their involvement actively sought. Residents or their relatives/representatives manage personal finances and the home does not involve itself with residents’ monies. The pre-inspection questionnaire shows that the equipment used in the home is regularly serviced and maintained appropriately. The fire logbook was looked at and it was noted that some of the necessary fire safety checks have Cheverells DS0000022173.V315517.R01.S.doc Version 5.2 Page 23 not always been carried out. Some staff working at the home have not had the mandatory fire training. Fridge, freezer and food temperatures are recorded daily and consistent records kept. Any incidents/accidents to residents in the home are recorded appropriately. The record keeping is generally satisfactory in the home, with the exception of those mentioned earlier in the report, in particular those relating to staff recruitment, medication and fire safety. Several radiators in the home remain uncovered and do not have low surface temperatures – risk assessments have not been fully completed. This was highlighted in the previous inspection and puts residents at risk of burning from hot surfaces. Some substances, which can be hazardous to health, were freely accessible from the laundry area and these must be secured to protect residents and visitors at the home. Cheverells DS0000022173.V315517.R01.S.doc Version 5.2 Page 24 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 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 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 2 3 X X X X X 3 3 STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X 2 2 Cheverells DS0000022173.V315517.R01.S.doc Version 5.2 Page 25 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 (1) a, b Requirement All residents living at the home require an assessment of need to be carried out on before they start to live in the home to ensure their needs can be fully met. When medicine is received into the home, it must be correctly recorded to ensure that the right amount of medication has been received by the home. When medicine is administered to people it must be clearly recorded to ensure that people receive the correct levels of medication. When medicine requires refrigeration, it must be kept within the specified temperature range to ensure it does not affect the way it works. When residents are supplied or administered with creams or ointments they must be recorded to ensure that they are having their treatments in accordance Cheverells DS0000022173.V315517.R01.S.doc Version 5.2 Page 26 Timescale for action 31/03/07 2. OP9 13(2) 31/03/07 with the directions of the prescriber. Previous timescale of 13/07/06 not met. 3. OP29 19 (1) (a)(b)(c) Schedule 2 1-7 No member of staff must be employed to work at the home without first obtaining all the necessary information required, in this case two written references and a POVA and CRB check. Previous timescale of 9/2/06 and 13/07/06 not met. Records relating to staff recruitment, medication and fire safety records must be held and up to date, containing all the information required. Radiators within the home must be assessed for the risk they present to the people that use the service and action taken to minimise any identified risk. Previous timescale of 20/01/06 and 13/07/06 not met. All substances which could be hazardous to health must be held safely and secured as necessary. All fire alarms and equipment must be tested and maintained in accordance with the necessary legislation. 10/01/07 4. OP37 17 (1)(2)(3) Sch 2, 3, 4 13 (4) (a) 10/04/07 5. OP38 10/04/07 6. OP38 13 (4) a,c 10/04/07 7. OP38 23 (4) a-e 31/03/07 Cheverells DS0000022173.V315517.R01.S.doc Version 5.2 Page 27 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 OP7 Good Practice Recommendations It is recommended that all care plans include more detailed information regarding social and personal care needs and that more information to demonstrate to staff how to meet specific resident’s needs. It is recommended that consent be obtained from residents or their representatives where bed rails are used. It is recommended that when an entry is hand written onto the Medicines Administration Record chart that this is signed and dated by the person making the entry and it is then checked and countersigned by a second person. It is recommended that medicines are only prepared for one resident at a time immediately prior to the administration taking place. It is recommended that the home review how the risk assessments for residents looking after their own medicines are reviewed and that relevant information is included in the care plan. It is recommended that all staff trained to administer medicines have their competence reviewed as part of the supervision process at least twice a year. It is recommended that all staff receive formal training in adult protection to ensure residents are safeguarded from abuse or harm. It is recommended that due to the layout of the home that staff have access to aprons and suitable handwash in each area of the home. It is recommended that the home involve the residents and their relatives in regular meetings to involve them in the running of the home and actively seek their opinions. 2. OP7 3. OP9 4. OP9 5. OP9 6. OP9 7. OP18 8. 9. OP26 OP33 Cheverells DS0000022173.V315517.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Devon Area Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 Cheverells DS0000022173.V315517.R01.S.doc Version 5.2 Page 29 - 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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