Inspection on 15/09/06 for Cheverels Care Home

This inspection was carried out on 15th September 2006.

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

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

Other inspections for this house

Cheverels Care Home 23/11/05

Cheverels Care Home 29/07/05

Cheverels Care Home 20/12/04

Cheverels Care Home 13/04/04

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Trevaylor Manor

12 Orchard Mews

Stallcombe House

Stepping Stones

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

CARE HOMES FOR OLDER PEOPLE Cheverels Care Home 52 Dorchester Road Maiden Newton Dorchester Dorset DT2 0BE Lead Inspector Rosie Brown Key Unannounced Inspection 10:15 15 & 20 September 2006 th th 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 DS0000043799.V314936.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. DS0000043799.V314936.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cheverels Care Home Address 52 Dorchester Road Maiden Newton Dorchester Dorset DT2 0BE 01300 320348 01300 321682 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) www.altogethercare.co.uk Altogether Care LLP Mrs Martina Goble Care Home 19 Category(ies) of Dementia - over 65 years of age (19), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (19), Physical disability over 65 years of age (19) DS0000043799.V314936.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd November 2005 Brief Description of the Service: Cheverels Care Home is registered to provide nursing care to a maximum of 19 elderly people with mental confusion and physical disability. On the day of the inspection there were 18 service users accommodated in the home. The home is established in a converted 16th century coaching house, which is situated in the middle of Maiden Newton. It is close to all local amenities, post office, public house, church and petrol station. The accommodation is available over two floors with the first floor access by passenger lift. The second floor provides two staff offices and a WC and accommodation for two members of staff. There is a small private garden with raised borders at the back of the home and a parking area for visitors use is available at the side of the house. The Registered Individual (RI) is Mr Peter Cotterill on behalf of Altogether Care LLP; the Registered Manager is Mrs Martina Goble. The pre-inspection questionnaire received in June 2006 notes that the fees for accommodation and care range between £515-£750. For interested consumers the web link to the Office of Fair Trading which is concerned with value for money and fair terms of contracts is: www.oft.gov.uk Web link to the report entitled Care Homes in the UK - A Market Study: http:/www.oft.gov.uk/NR/rdonlyres/5362CA9D-764D-4636-A4B1A65A7AFD347B/0/oft780.pdf The home’s service user guide notes that a copy of the home’s latest inspection report is available in the home’s lounge. Alternatively inspection reports can be downloaded for free from our website: www.csci.org.uk DS0000043799.V314936.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 the 15th September 2006 between the hours of 10.15am and 2.50pm. Because the manager had another engagement in the afternoon the inspector returned to complete this key inspection on 20th September between the hours of 10am and 3pm. This was the first key inspection of the home for this year and another will follow at a later date. The purpose of the inspection was to review 21 of the National Minimum Standards and to review progress with requirements and recommendations set out in the previous inspection report. Information was gathered through discussion with the manager, Mrs Martina Goble, a brief discussion with Mr Westlake during the afternoon of 15th September, two service users and nine staff on duty during the time of the inspection visits. The inspector used observation skills to access some of the findings. The communal areas and a selection of residents’ rooms were seen during the visit, resident’s care records, staff records and maintenance records were examined and the home’s policies gave further information. Prior to this inspection, comment cards supplied by the Commission were returned. These included seven survey forms from residents (mostly completed by helpful relatives), nine cards and one letter from a relatives, three from care professionals that are in regular contact with the home and two from GP’s. The majority of comments were complimentary about the care provided to residents and the information within them has been used in the report. The manager’s pre-inspection questionnaire completed and returned to the Commission in June 2006 has also been used to provide information. What the service does well: Cheverels Care Home provides a good standard of nursing care for residents who have diagnosed mental health conditions in a family style environment. The manager undertakes a thorough pre admission assessment for all prospective residents and ensures that a comprehensive care plan is in place for their care prior to admission. The manager ensures that residents’ care plans and associated riskassessments are reviewed each month and updated at times of significant change. The manager and part-time activities organiser have set up a therapeutic social care programme which mainly focuses on the individual needs of DS0000043799.V314936.R01.S.doc Version 5.2 Page 6 residents: the whole emphasis being on staff working with a calming approach so that confused residents are listened to and regularly given one to one time. The food served to residents is freshly baked each day and special diets are catered for, for example one diabetic resident is supplied with sugar free puddings and cakes, gluten free products are used for one resident and pureed meals and soups provided to seven residents who experience difficulty swallowing or chewing. Care plans include details of nutritional assessments and details relating to dietary needs: relevant information about residents’ specific preferences and needs is also kept by the cook in the home’s kitchen. It was evident during the inspection that the staff team work consistently with residents to ensure their needs are met, e.g. although there is only one assisted bathroom staff bath residents throughout the day and at other necessary times: there is no rigid routine although a weekly checklist is also used to encourage bathing. What has improved since the last inspection? What they could do better: DS0000043799.V314936.R01.S.doc Version 5.2 Page 7 Nursing staff should routinely date tubs and tubes of creams and other skin care preparations used so that products are not used beyond their expiry date. Although a good staff training programme is in place, the manager and senior staff must undertake the advanced 2-day local POVA/No Secrets training provided by the local authority to ensure the home and staff are fully informed about the local processes and procedures: the information gained should then be shared with the staff team. The plans building works and improvements to the environment should be progressed as soon as practically possible: an action plan should be drawn up to demonstrate how the home will ensure that the residents living in the home are protected from too much disruption to their daily lives. All new staff including domestic workers must not commence working in the home without their CRB disclosure satisfactorily returned and no POVAFIRST check in place as this puts service users at potential risk of harm. A copy of the Department of Health’s guidance for infection control and ‘Heat wave’ guidance concerning the actions to be taken to protect vulnerable people should be obtained. The home’s policies and procedures concerning infection control should be updated and a ‘Heat wave’ plan detailing resident’s collective and individual needs should be drawn up. This information is available at: www.dh.gov.uk/publications The home’s current fire risk-assessment must be updated to include the actions regarding evacuation from the second floor in the event of a fire and the home should contact Dorset Fire & Rescue Service to discuss and seek advice on this matter. Additionally, the home’s policy concerned with fire safety should be updated to reflect new legislation. Management have yet to ensure that the all health and safety aspects of residents’ care is being promoted particularly in relation to improvements needed in the environment, e.g. protecting of central heating radiators, the provision of a reliable call system and a second assisted bathroom for routine use in the home. 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. DS0000043799.V314936.R01.S.doc Version 5.2 Page 8 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 DS0000043799.V314936.R01.S.doc Version 5.2 Page 9 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 Standard 6 does not apply Quality in the outcome area is good; this judgement has been made using available evidence including a visit to this service. The manager undertakes a comprehensive pre admission assessment of each service user’s needs prior to admission to ensure their needs can be met by the home. The home does not provide intermediate care. EVIDENCE: The care records for two recently accommodated residents were examined and evidenced that the manager undertakes pre admission assessment of each prospective service user’s care needs prior to admission. Details and information obtained included all topics recommended in the National Minimum Standards, family history and personal profiles and other important information associated with their mental health from other care professionals and family. DS0000043799.V314936.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in the outcome area is good; this judgement has been made using available evidence including a visit to this service. The manager ensures that a care plan is in place for each resident and identified the care needs to be met by staff: information contained in care plans is shared with relatives. Residents’ health needs are monitored and responded to appropriately with support from community services. The manager has set up a good system for managing residents’ medicines and records seen indicated that medicines are administered as prescribed by a registered nurse. It was evident from observation and records kept in the home that residents are treated respectfully by staff. EVIDENCE: Care plans and care records for two residents were examined and included details of personal hygiene and wound care, elimination, nutrition and special diets, mobility, sleeping arrangements and patterns, communication, sensory DS0000043799.V314936.R01.S.doc Version 5.2 Page 11 needs, psychological needs, mental health issues, safety, social interaction and activities, health, foot care and oral hygiene. Some but not all care plans include information concerned with care wishes when a resident becomes critically ill or are dying. Care related risk-assessments are in place and include the following care needs; nutrition and special diet, falls, wound care, social care, mobility, self neglect, challenging behaviour, short term memory problems, the use of bed rails and residents’ vulnerability to the hot surface temperatures of central heating radiators. Care records evidenced that regular and appropriate contact is made with care professionals for further advice and guidance and that they are reviewed each month and updated following a change in care needs. The manager has set up an audit system to monitor falls and incidents that arise in the home. Individual records of all accidents and incidents are recorded promptly. One particular case was discussed and the manager changed one person’s care plan to include continence care and management during the night. The home has a treatment room where the medicines trolley is stored the door to this room is locked. All residents’ medication is kept and managed by the home. The registered nurse in charge of each shift administers medication and holds the key to the drugs trolley controlled drugs cupboard and treatment room. The medication stocks were checked briefly as were residents’ individual administration record (MAR) charts. Arrangements are in place for the proper disposal of medicines no longer in use and comply with legislation. Improvements have been made to ensure that the maximum and minimum temperatures of the medicines fridge are monitored daily. While viewing residents rooms the inspector noted that some creams were openly stored in rooms and the nurse was reminded that each pot or tube of cream must be dated when opened: the date of opening all creams should be maintained so that they are not used beyond the recommended expiry date. Since the previous inspection the home’s medicines policy has been reviewed and updated as recommended by the CSCI pharmacist, e.g. it now reflects that nurses give medication, not care staff. Prior to this inspection a number of cards were received from residents, their relatives and representatives and all commented that resident’s privacy is always respected: staff were observed to be patient and calm during both visits. One relative’s comment card states: ‘My relative is unable to express her opinion on the quality of care, but I am confident that she is well cared for’. DS0000043799.V314936.R01.S.doc Version 5.2 Page 12 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 the outcome area is good; this judgement has been made using available evidence including a visit to this service. Comment cards confirmed that staff in the home welcome and encourage contact with friends and relatives/representatives. Future plans are to provide more communal space where visitors can meet with service users in private. A regular and varied programme of activities is provided for residents by staff and the part-time activities co-ordinator. It was evident during the inspection that residents’ individual expectations and personal daily choices are honoured by staff. Residents are supplied with three meals a day, the food is home baked each day and the menu including residents’ favourite foods, special diets and requests. EVIDENCE: As noted in previous reports due to high degrees of confusion amongst service users, it is difficult to engage meaningfully with residents about life in the home. DS0000043799.V314936.R01.S.doc Version 5.2 Page 13 Seven residents comment cards were received prior to the inspection (mainly completed by relatives) that confirmed they like are well cared for by staff during conversation with staff it was evident they are familiar with residents’ daily routine preferences and care needs. For the past year the home’s activities programme has been developed: individual social care needs are integrated into each residents care plan. Records evidenced that a variety of calming activities take place, these include, reflexology, aromatherapy, gentle exercise, craftwork, memory box discussions and weekly trips out for individuals or small groups. A discussion took place concerning the need to maintain and improve this development and it is recommended that the part-time activities co-ordinator be employed full time. On the morning of the inspection one resident was enjoying reflexology. It is evident that one particularly frail resident has benefited from regular aromatherapy massages. The inspector spoke with three residents during the visit who appeared to be happy and relaxed. One comment card confirmed that a relative had spent time in the home over the Christmas period (2005) and the manager confirmed that family members are often supplied with lunch when they visit. The home achieves a high standard regarding food provision. A weekly menu is used and incorporates seasonal vegetables and fruit and the manager explained that the menu had just been changed from summer to autumn options. The daily menu offers a choice at each meal, includes specific likes and dislikes and special dietary needs, e.g. diabetic or soft food. The cook showed the inspector the food products used for a resident with celiac problems. Special nutritional and dietary needs are included in residents’ care plans: some service users are assisted to eat while others are monitored either because they would not eat enough or would eat too much food if unsupervised. Meals are served in two sittings to ensure that each resident receives the attention and assistance they need. Meals are eaten in the dining room or in residents’ rooms. A letter received by the Commission from a relative notes: ‘I visit x on a weekly basis and have been very impressed with the care provided by all staff. They are always friendly and attentive and I am confident that x’s welfare is in good hands’. DS0000043799.V314936.R01.S.doc Version 5.2 Page 14 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 the outcome area is good; this judgement has been made using available evidence including a visit to this service. The home has a complaints policy and procedure, which enables residents and their representatives/advocate to raise concerns: all concerns are taken seriously and addressed by management. The home has guidance available on the response that should be made to any suspicion or allegation of abuse and the manager has familiarised staff with the local ‘No Secrets’ guidance to properly ensure that service users are routinely protected. EVIDENCE: The home has a complaints procedure and this is supplied to prospective residents, their relatives or representatives during admission for future reference and use. The home keeps a complaints book and management (Altogether Care) take all complaints seriously: one complaint has been received since the previous inspection. Prior to this inspection the Commission received a comment card accompanied by letters concerning the complaint that had been responded to by the manager. The complaint concerned the relative’s dissatisfaction about Boxing Day: issues were insufficient heating, the cold food supplied and medication being left with a resident. The manager investigated the concerns and responded to the relative. DS0000043799.V314936.R01.S.doc Version 5.2 Page 15 The home’s current heating system is old and temperamental at times and certain parts of the home feel cooler than others due to there position: it is hoped that this situation will be completely remedied when the planned alterations to home are undertaken, in the meantime portable heaters are made available when problems arise. Staff on duty on Boxing Day reported no problems with the heating. Residents were supplied with a variety of cold meats and bubble & squeak for lunch: the relative and resident were served lunch in the dining room after other residents had eaten to aid privacy and enjoyment. The chef reported that the bubble & squeak was hot when it left the kitchen. Medication was left with one resident but staff are trained to observe that it has been taken, the resident concerned becomes very agitated if staff sit or stand next to them and this has been deemed the best course of action using a risk-assessment process. The manager explained she has done her best to resolve this complaint. As noted earlier because residents’ communication skills are limited it was difficult to establish from them how they would complain. However to ensure residents’ individual rights are promoted the manager has established a key worker system. The home keeps a copy of the local ‘No Secrets’ and a procedure to following regarding the identification of abuse and the appropriate response to allegations of abuse. Additionally, there is a copy of the POVA guidance kept in the staff room. Staff sign to acknowledge they have read and understand both sets of guidance. The home also has policies regarding the recognition and prevention of abuse. Staff are supplied with training concerned with abuse during their induction and this subject is also covered during NVQ2 training. The manager and senior staff have yet to attend a two-day POVA/ No Secrets awareness course provided by the local Authority training department. Notifications of untoward events relating to care are forwarded to the Commission as required and indicate that action is taken to prevent recurrence. However, when checking the maintenance book it was noted that the passenger lift had broken down: there must be a plan of action regarding the arrangements in place for each resident so that they have access all communal facilities and their rooms in the event of passenger lift failure. Since the previous inspection the home has referred one adult protection issue to Adult Services and this related to an unexplained injury. The injury and surrounding circumstances were investigated and there was no evidence of abuse. DS0000043799.V314936.R01.S.doc Version 5.2 Page 16 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 the outcome area is adequate; this judgement has been made using available evidence including a visit to this service. The home is clean throughout, attractively decorated and comfortably furnished creating a homely atmosphere for residents to live in. However, several bedrooms are shared, the call facility is old and rarely used and central heating radiators are not guarded therefore the environment is not safe and this compromises residents safety. EVIDENCE: As noted in previous inspection reports the home has a ground floor lounge with a separate dining room both are pleasantly decorated and comfortably furnished. Bedrooms are situated on the ground and first floor of the home and the first floor is accessed by the main staircase or passenger lift. There are seven single bedrooms and six shared bedrooms: five single rooms and one of the shared rooms have en-suite facilities. Four bedrooms are under the recommended DS0000043799.V314936.R01.S.doc Version 5.2 Page 17 size: two single and two doubles, and this means that staff have to move furniture around when specific equipment/aids are used. One comment card from a care professional makes the following observation: ‘The service user was accommodated in a shared room which I felt was dark/ill lit poorly decorated and cramped and beds were against both walls with no access around them: I feel shared rooms are not appropriate in this day and age’. The Commission has received copy of the plans for development and improvements and was told by Mr Westlake that they have now been approved. A discussion took place later with the manager about the need for a plan of action to be drawn up in relation to the anticipated building works to ensure the least possible disturbance to the resident group. The majority of the bedrooms viewed were personalised with residents’ possessions and individual inventories of belongings brought into the home are kept. The home’s call facility is old with box style handsets that are damaged with press buttons indented; these are difficult for elderly frail and confused residents to use. The Commission has been informed that this facility will be upgraded when building works are commenced. However, the inspector is concerned that there is basically an unreliable call system that is rarely used. There is one large WC situated on the ground floor and two bathrooms with toilets on the first floor. One bathroom is assisted and fitted with a bath chair, it is well used but the bath enamel is chipped and as noted before, remains a possible source of cross infection. Staff said the other bathroom is rarely used and the manager explained it is not used because the majority of residents are physically frail and the portable bath seat available is not suitable for their needs. It is understood that the plans for development include improved bathing facilities. Two members of staff reassured the inspector that residents are bathed daily and more often when necessary of the current service user group: the staff team obviously work very hard to alleviate the shortfall in current bathing facilities. Radiators in bedrooms and communal areas are not guarded and the manager has drawn up individual risk-assessments regarding their vulnerability to hot surface temperatures and burns. The inspector is aware that the central heating system is old and is being replaced when building work is commenced. However, the central heating system must be upgraded and protected as soon as possible to ensure that residents are not at risk of accidental harm. The second floor of the home is used for staff accommodation and two staff offices. Since the previous inspection the doors to both staff offices have been fitted with magnetic holdback devices to prevent the propping open of fire doors. DS0000043799.V314936.R01.S.doc Version 5.2 Page 18 A discussion took place regarding the issue that there is no alternative fire exit apart from the main staircase from the second floor and this matter has been referred to the Dorset Fire & Safety Service. In the meantime the home’s fire risk-assessment must be updated to include the arrangements for evacuation in the case of a fire on the second floor of the home. Some time was also spent considering the guidance for homes related to the Regulatory Reform (Fire Safety) Order that comes into force in October 2006. Guidance is available at: www.firesafetyguides.communities.gov.uk The most recent visit by the Environmental Health Officer (EHO) identified minor issues requiring attention in relation to the home’s kitchen and these have been remedied. While viewing the kitchen it was noted that the home would benefit from a larger fridge and it is recommended that this situation is resolved as soon as possible. The current fridge/freezer is domestic in style and fridge space is very limited for storing prepared foods before a meal, large dessert that looked most delicious and should have been chilled until served had to be left out on a kitchen top. The home’s laundry is currently established in an outbuilding and previous inspection report had identified that when staff are undertaking laundry tasks, particularly at night they are not easily contacted and available for service user assistance if necessary because there is no call system available. The manager stated that a new domestic/laundry assistant post had just been filled and the assistant had been employed for a week. However, care staff continue to help with laundry tasks when the laundry assistant is off duty. A domestic assistant/cleaner is employed for 38 hrs per week and on both days of the inspection was seen working in the home: the home was clean with no unpleasant odours apparent. Since the previous inspection a handyman/gardener has been employed to work in the home. DS0000043799.V314936.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in the outcome area is good; this judgement has been made using available evidence including a visit to this service. The staff rota confirms that a registered nurse is on duty 24hrs each day supported by health care assistants and some domestic/ancillary staff. A staff training programme including induction and NVQ2 training is in place to ensure that staff have the skills necessary to care for residents who are mentally frail. A staff training and supervision programme is also in place and the manager ensures that information and training specifically related to the diagnosed conditions of residents is available. The manager uses a standard company staff recruitment and employment procedure. However, all new staff including domestic workers must not commence working in the home without their CRB disclosure satisfactorily returned and no POVAFIRST check in place as this puts service users at potential risk of harm. EVIDENCE: The staff team comprises of 4 registered nurses and 9 care assistants (CA), four CA’s have NVQ 3 qualifications: other care staff are also are undertaking NVQ level 3 training in care. Normally the manager works each weekday and DS0000043799.V314936.R01.S.doc Version 5.2 Page 20 her hours total approximately 42hrs: when necessary she works as part of the care team in a nursing/care capacity. On the day of the inspection the manager was working with one registered nurse and three care assistants: other staff on duty included a domestic/cleaner, the activities organiser, the laundry assistant, handyman/gardener and a cook. Agency staff were being used occasionally during the summer months but not at the moment. The manager said that although the staff team is small and most live locally they are currently happy to cover most shortfalls that arise unexpectedly. Two nursing staff also live in rooms on the second floor of the home and are called upon if necessary. As stated in other reports recruitment can be difficult because the home is situated in a quiet rural village, but this home must continue to ensure sufficient care staff are employed to ensure that cover is available during staff leave, official pregnancy breaks and in unexpected situations. The rota demonstrates that there is a trained nurse on duty with 3 care staff from 8am to 8pm each day. During the hours of 8pm and 8am there is one wakeful nurse and one care assistant on duty and at the current time these arrangements appear to be satisfactory. During this and the previous inspection a discussion took place concerning the need for the manager to be supported by the employment of a deputy manager/head of care to provide management cover when the manager is off duty. Earlier in this report there is a recommendation that the activity organiser is employed for more hours to continue with the developing of social provision and individual attention and stimulation. The home was able to evidence that the staff-training programme includes a supervised Skills for Care induction process. Additionally, two individual staff training files indicated that all statutory training is supplied. The manager said she is continuing to develop other aspects training directly relevant to resident’s individual needs and topics include: Dementia Training with a BTEC certificate, the principles and practices of palliative care, oral health promotion, optical awareness, understanding diabetes and resuscitation and anaphylaxis. The recruitment records for the two most recently recruited members of staff were examined. These demonstrated that all relevant references and checks were undertaken and on file for a nurse who has been working in the home for some time and for the laundry assistant who has been working in the home for approximately one week. DS0000043799.V314936.R01.S.doc Version 5.2 Page 21 The CRB and POVAFirst check had been receive for the nurse but has yet to be received for the laundry worker. There was written evidence to demonstrate that the manager provides regular supervision of all staff including nurse’s clinical supervision. Comment cards received prior to the inspection were complimentary about the staff that work in the home. One relative noted, ‘The nursing staff are friendly and caring’. While a care professional commented ‘ The senior members of staff have a clear understanding of the needs of the people they care for and those of the carers’. One relative who spoke with the inspector on day two was full of praise for the hard working staff team who provide excellent care to their relative. Staff on the day were observed to be entirely patient and helpful with residents. DS0000043799.V314936.R01.S.doc Version 5.2 Page 22 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 the outcome area is adequate; this judgement has been made using available evidence including a visit to this service. The registered manager is trained and experienced, however, she is due to cease working in the home on September 26th 2006. She is supported by regular visits from the RI (Mr Cotterill) and Chief Executive (Mr Westlake) of the company to ensure that service users are properly cared for. Management have set up standard Altogether Care policies and procedures to ensure that staff are supplied with guidance regarding the expected practices associated with residents’ care and these are subject to annual review. Management have yet to ensure that the all health and safety aspects of residents’ care are being promoted: plans have recently been approved to develop the home and improve facilities. DS0000043799.V314936.R01.S.doc Version 5.2 Page 23 EVIDENCE: The manager has relevant NVQ management training and training in Dementia Care, she has several years experience at working in a residential environment. The manager recently wrote to the Commission to inform us that she will cease working in the home on September 26th 2006 due to a career move. Mr Westlake told the inspector that advertising to fill the post has commenced. In the meantime the RI must write to the Commission to inform them of the management arrangements being put in place until a new manager is recruited. Mr Cotterill (RI) has been nominated to undertake Regulation 26 visits and although the manager confirmed that these visits take place there were no reports sent tot the home to evidence them. All new staff are supplied with induction training and mandatory training that meets Skills for Care specifications and the manager is developing the training provision in the home to incorporate other subjects. The manager showed the inspector recent external quality assurance survey forms and has yet to summarise the findings: main issues relate to the improvements needed to upgrade the environment. The manager keeps personal allowance for approximately half of the resident group. Each person’s money is kept separately in a locked drawer and a record of all expenses with receipts is kept and signed: four resident’s money was sampled and funds held tallied with the record held. A copy of the Department of Health’s guidance for infection control and ‘Heat wave’ guidance concerning the actions to be taken to protect vulnerable people should be obtained. The home’s policies and procedures concerning infection control should be updated and a ‘Heat wave’ plan detailing resident’s collective and individual needs should be drawn up. The home’s fire risk-assessment will need updating in the light of new legislation and should identify recommendations for improvements to the fire safety system where necessary. The home’s fire risk assessment has been updated to make reference to each room/en-suite and cupboard where extractor fans are fitted and a cleaning schedule is now in place: further advice should be sought from the Fire Safety Officer for the home. In the meantime the risk-assessment must detail the arrangements for evacuating the second floor of the home. DS0000043799.V314936.R01.S.doc Version 5.2 Page 24 Maintenance records evidence that routine checks of the central heating system, hot water supply, sluice facility, passenger lift and moving and handling equipment and certificated documentation is in place. Until improvements are made to the environment, e.g. the protecting of central heating radiators and a call bell system that is easily accessible and used, this standard remains unmet: see requirements and recommendations in this report. DS0000043799.V314936.R01.S.doc Version 5.2 Page 25 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X 2 2 DS0000043799.V314936.R01.S.doc Version 5.2 Page 26 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. Standard Regulation Requirement The home must report all untoward incidents that may affect the well being of a residents including passenger lift breakdown. (Following the inspection Mr Westlake provided a copy of a new policy concerning the actions to be taken in the event of passenger lift problems). The manager and senior staff must undertake the advanced 2day local POVA/No Secrets training to ensure the home and staff are fully informed about the local processes and procedures: the information gained should then be shared with the staff team. (Previous timescale of 31/01/06 not met). All radiators must be guarded or have guaranteed low temperature surfaces to ensure residents’ health & safety at all times. (Previous timescales of 1/2/05. and 31/10/05 not met although risk-assessments are in place remedial action has not been undertaken). The Commission has received plans to extend and refurbish the home during 2006. DS0000043799.V314936.R01.S.doc Timescale for action 1. OP8 13 (4) (c) 31/10/06 2. OP18 18 31/12/06 3. OP19 13(4)(c) 31/12/06 Version 5.2 Page 27 4. OP19 23(2)(1) 5. OP19 23(2)(j) 6. OP19 23(2)(m) 7. OP19 13(4)& 23(5) 9. OP19 23(2) The registered persons must ensure that there are adequate storage areas for incontinence supplies and other items of equipment. (Previous timescales of 31/10/05 and 31/03/06 not met). The Commission has received plans to extend and refurbish the home during 2006. The second bathroom must be upgraded to ensure it is more suitable for residents’ bathing needs. Measures must be taken to ensure that the damage to the bath enamel in the assisted bathroom does not promote cross infection. (Previous timescales of 31/10/05 and 31/03/06 not met). The Commission has received plans to extend and refurbish the home during 2006. The old call system must be replaced with a more suitable system that suits the needs of service users and be available for use in all communal rooms. (Previous timescales of 31/10/05 and 31/03/06 not met). The Commission has received plans to extend and refurbish the home during 2006. The registered persons must consult with the Fire Safety Officer to discuss the action to be undertaken regarding the lack of an alternative fire exit on the 2nd floor of the home. (The inspector contacted Dorset Fire & Rescue Service to alert them to this situation following this inspection). The central heating system must be repaired or replaced so that it functioning properly. The Commission has received plans to extend and refurbish the home during 2006. DS0000043799.V314936.R01.S.doc 31/12/06 31/12/06 31/12/06 31/10/06 31/12/06 Version 5.2 Page 28 10. OP29 18 &19 11. OP27 18 12. OP19 13 (4) (c) (The manager has said that in the meantime portable heaters are made available if necessary). All new staff including domestic workers must not commence working in the home without their CRB disclosure satisfactorily returned and no POVAFIRST check in place as this puts service users at potential risk of harm. The manager must be able to work in an additional capacity to the staff team. Consideration must be given to the employment of a deputy manager to provide management cover when the manager is off duty, this person could also work as part of the staff care team. The home must employ permanent staff in sufficient numbers. (The previous inspection report acknowledged that the home is recruiting for new staff). The home’s current fire riskassessment must be updated to include the actions regarding evacuation from the second floor in the event of a fire. Advice on this matter should be sought from the Fire Safety Service. 31/10/06 31/10/06 31/10/06 DS0000043799.V314936.R01.S.doc Version 5.2 Page 29 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. Refer to Standard OP9 OP19 Good Practice Recommendations All prescribed tubs and tubes of cream and other skin preparations used to prevent skin breakdown should be dated when opened. More refrigerator storage space should be provided in the home’s kitchen. The registered persons should consider how to provide a comfortable place where visitors can meet with service users in private particularly because there a several shared bedrooms in the home. (The Commission has received plans to extend and refurbish the home during 2006 until completion of these works this situation remains unresolved). The home’s fire risk assessment should be up dated to reflect the recent changes in legislation and remedial action should be taken where identified. (Following the inspection Mr Westlake supplied a copy of the companies updated fire safety policy). A copy of the Department of Health’s guidance for infection control and ‘Heat wave’ guidance concerning the actions to be taken to protect vulnerable people should be obtained. The home’s policies and procedures concerning infection control should be updated and a ‘Heat wave’ plan detailing resident’s collective and individual needs should be drawn up. 3. OP13 4. OP38 5. OP38 DS0000043799.V314936.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 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 DS0000043799.V314936.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!