Inspection on 05/08/08 for Church View (Residential Home) Limited

This inspection was carried out on 5th August 2008.

CSCI found this care home to be providing an Adequate service.

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

Church View (Residential Home)... 03/11/09

Church View (Residential Home)... 21/08/07

Church View (Residential Home)... 20/06/06

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 29/01/2009.

CARE HOMES FOR OLDER PEOPLE Church View (Residential Home) Limited Church Street Oswaldtwistle Lancashire BB5 3QA Lead Inspector Mrs Jane Craig Key Unannounced Inspection 5th August 2008 09:15 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 Church View (Residential Home) Limited DS0000066410.V365687.R02.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. Church View (Residential Home) Limited DS0000066410.V365687.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Church View (Residential Home) Limited Address Church Street Oswaldtwistle Lancashire BB5 3QA 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) 01254 381652 01254 239863 Church View (Residential Home) Limited Kelly-Ann Groves Care Home 32 Category(ies) of Old age, not falling within any other category registration, with number (32) of places Church View (Residential Home) Limited DS0000066410.V365687.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 32 service users, to include: Up to 32 service users in the category of OP requiring personal care. Date of last inspection Brief Description of the Service: Church View Care Home Oswaldtwistle was purpose built in 1988. It is a single storey building, with level access, situated in its own well-kept grounds. The home is in the centre of the town of Oswaldtwistle, close to all local amenities. Church View Care Home is registered to provide 24-hour personal care for up to 32 people. Accommodation is offered in single en-suite bedrooms. Communal rooms include 3 lounges and 2 dining rooms. The garden is easily accessible to all residents. The current fees charged at Church View range from £346 per week for those people who are funded by the local authority to £418 per week for people who are self funding. Additional charges are payable for hairdressing, newspapers and toiletries. A fee is also charged should people require a staff escort to attend appointments. The statement of purpose and service user’s guide were on display in the home. Church View (Residential Home) Limited DS0000066410.V365687.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. A key unannounced inspection, which included a visit to the home, was conducted at Church View Residential Home on the 5th August 2008. At the time of the visit there were 28 people living at the home. The inspector spoke with a number of them and some of their comments are included in this report. Three people living at the home were case tracked. This meant that the inspector looked at their care plans and other records and talked to staff about their care needs. As part of the key inspection a number of surveys were sent out to people living and working at Church View. Four people using the service and five members of staff completed surveys. During the visit discussions were held with the senior in charge of the home, the area manager, other members of the staff team and three visitors. The inspector looked round the home and viewed a number of documents and records. This report also includes information from the Annual Quality Assurance Assessment (AQAA), which is a self-assessment that the manager has to fill in and send to the Commission every year. What the service does well: Staff were seen to assist residents in a friendly and polite manner. They were aware of the importance of promoting people’s privacy and dignity. A resident described staff as, “respectful.” People using the service said they were satisfied with their care. One person said, “Day or night press your buzzer and someone will come.” Another person said that they were well looked after and felt better since being at the home. Most family carers also said they were happy with the care their relative received. Although there was a lack of choice for the main meal, everyone who was asked said they liked the food. One person said, “The food is lovely and you get more than enough.” Church View (Residential Home) Limited DS0000066410.V365687.R02.S.doc Version 5.2 Page 6 There was open visiting at the home which meant that people could see their visitors at times that were convenient to everyone. The staff organised ministers from the local churches to come into the home to see people who wished to practise their religion. People using the service were given a copy of the complaints procedure and everyone who returned surveys said they knew who to speak to if they were unhappy about their care. People living at the home all had their own room and toilet. Those spoken to were happy with their accommodation. They said, “I think my room is lovely,” “The bed’s lovely and comfortable,” and “I’m happy with my room; no complaints.” People who returned surveys indicated that the home was clean and fresh. People said they got on well with the staff. One person said, “everyone is assigned to a carer and they look after you and talk to you.” A relative described staff as, “kind and caring.” The recruitment procedures were very thorough and made sure that people were properly checked before they came to work at the home. This protected residents. More than half of the care staff held an NVQ, which is a nationally recognised qualification in care. What has improved since the last inspection? Information about the home was more accessible to people thinking of moving in. The welcome pack helped people to understand what they could expect. People received a contract or terms and conditions of residence at the point of moving into the home. This helped people to understand their rights and prevent any misunderstandings. There were more details about the usual or preferred routine of residents in their assessments. This helped staff to know how people like to spend their day. There had been improvements to the laundry. Staff had been appointed to work specifically in the laundry, which left care staff to concentrate on care duties. The laundry was sufficiently well equipped and one person remarked that they sent their laundry one day and it came back the next. Staff had fire safety drills at least twice a year. This helped them to become familiar with the fire procedure and protect the safety of everyone in the home. Church View (Residential Home) Limited DS0000066410.V365687.R02.S.doc Version 5.2 Page 7 What they could do better: Care plans should be more person centred so that they take into account people’s individual wishes and preferences. To ensure that staff are always providing the right care, plans must be kept under review and brought up to date whenever the resident’s needs change. In order to protect the health and safety of people living in the home, risks to their health must be assessed. Plans to minimise the risks must be put into place and kept under review. Medication practices were not completely safe and could place people at risk. The staff who are responsible for managing medication must make improvements in the way medicines are recorded and administered. Although there had been some improvement in the level of activities, the current programme did not meet the needs of a number of people. Two who returned surveys indicated that there were never any suitable activities and people said they spent most of their time watching TV. There should be an alternative meal at lunchtime so that everyone has a choice for his or her main meal. All staff must receive training in safeguarding adults so that they know what to do if they see, hear or suspect something is not right. There should be clear guidance for senior staff to ensure they understand their role in reporting abuse outside the home. Staff should have up to date guidance and training in infection control procedures. Practices that increase the risk of spread of infection, such as sharing combs, should stop. All staff should receive training in safe working practices so that they remain aware of good practice and can protect the health and safety of residents and themselves. A system for reviewing and improving the quality of care should be established and maintained so that issues requiring attention are identified and can be acted upon in a timely manner. These systems should include obtaining the view of residents and relatives. In order to safeguard people using the service the staff must keep accurate and complete records of any money they look after or spend on behalf of residents. Church View (Residential Home) Limited DS0000066410.V365687.R02.S.doc Version 5.2 Page 8 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Church View (Residential Home) Limited DS0000066410.V365687.R02.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Church View (Residential Home) Limited DS0000066410.V365687.R02.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People had sufficient information to enable them to make a decision about moving into the home but shortfalls in the assessment process meant that staff did not always have sufficient information about the person’s needs. EVIDENCE: The statement of purpose and service user’s guide were on display in the home, as was the last inspection report. Anyone moving in was also given a welcome pack. This provided comprehensive information about the day to day routines in the home and gave new people an idea of what they could expect. New residents, including those admitted for short-term care, were provided with a contract or terms and conditions of residency. Church View (Residential Home) Limited DS0000066410.V365687.R02.S.doc Version 5.2 Page 11 People thinking of moving into the home were assessed by health and/or social care professionals and by the manager. However, there was not always enough information gathered to fully understand their needs before they came into the home. For example, the social service’s assessment for one person indicated that they had a history of swallowing difficulties but the assessment had not been received until a month after their admission. It had not been identified on the home’s assessment, which meant that the person had been admitted without the full extent of their needs being known and understood by staff. Staff said that seniors talked to them about any new people coming in and one member of staff who returned a survey wrote that they were always given the relevant information about any newcomers. Following a previous recommendation anyone moving into the home received a letter confirming that their needs could be met. Standard 6 was not applicable. Church View did not provide intermediate care. Church View (Residential Home) Limited DS0000066410.V365687.R02.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The lack of consistency in health and personal care planning and delivery could compromise people’s safety or result in their needs not being met. EVIDENCE: Care records for three people were inspected as part of the case tracking process and others were looked at to check specific issues. Some plans were person centred. For example there were good directions on one plan as to how staff could help the person to communicate. Other plans did not give any information about the person’s individual strengths and needs or how they wished to be supported. For example, the care plan for one person instructed staff to, ‘ensure that he is washed and dressed.’ Church View (Residential Home) Limited DS0000066410.V365687.R02.S.doc Version 5.2 Page 13 Care plans were reviewed every month. There were no evaluation notes to indicate whether the planned care was effective and people were making progress towards meeting their goals. There was evidence that some plans were updated at the time of the monthly review but they were not always changed as and when the person’s needs changed. Some care plans had not been updated at all. For example, one care plan stated that the person had a soft diet and did not eat meat but this had not been the case for some time. Not updating care plans could result in staff not providing the right care. This is especially important as more than one of the staff who returned surveys wrote that they used the care plans to keep up to date about people’s needs. There was evidence that people using the service, or their relatives, had opportunities to discuss their care plans. Health care risk assessments were on files but they were not always complete, which meant the level of risk was not always accurate. For example, a falls risk assessment for one person indicated the level risk was medium but if it had been completed accurately it would have shown the person to be high risk. The lack of accurate assessment information meant that care plans might not accurately reflect the level of need. Not all risk assessments were kept up to date. Accident records for two people indicated that they had both recently had a number of falls during the night but their risk assessments had not been altered to reflect this change. Plans to minimise the risk of falls had not been updated. In general there was a lack of consistency in the strategies for controlling risks to health and safety. For example, two people were assessed as being at risk of developing pressure sores. One had a prevention plan but the other did not. Despite these shortfalls people said they were happy with the care they received. A number of people said they were well looked after. One person said, “day or night, if you press your buzzer someone will come.” Two out of three relatives said that they were satisfied with the care at the home. One said, “We have been generally pleased and happy with the care my mother is receiving.” The other relative said that they were not completely happy with the home. They said that their relative was not supervised sufficiently when taking medication and was sometimes wearing dirty clothes. They said they had brought this to the attention of the staff but it had not been rectified. People who administered their own medicines had risk assessments. Care plans indicated that staff should carry out regular checks to ensure the person was still safe and able to manage but there were no records of these checks taking place. Medicines were stored safely. Those with a short shelf life were dated on opening to ensure they were discarded after the recommended time. Church View (Residential Home) Limited DS0000066410.V365687.R02.S.doc Version 5.2 Page 14 There were records of medicines received into the home and of those awaiting return to pharmacy. There were records of medication carried over from the previous month, which helped to maintain an audit trail. There were few gaps on medication administration record (MAR) charts. With the exception of food supplements, appropriate codes were used to indicate when and why medicines were omitted. There were instructions to alert staff when to give medication that was prescribed ‘when required’. This helped to reduce the risk of over or under medicating. Variable doses were not always recorded, which meant that staff could not evaluate the effectiveness of a particular dose. Handwritten entries on MAR charts were not double signed, which increased the risk of transcribing errors. Staff had altered medicine for one person from twice a day to ‘as required’. There was no authorisation for this, which meant that the person was not being offered their medication as prescribed by their doctor. One person was missing their morning medication because they liked to sleep late. Discussions took place as to how staff could make alternative arrangements for people who like to stay in bed late to ensure that they received essential medication. Controlled drugs were stored and recorded according to good practice guidance. One person had received their dose of painkillers a day late but records showed this was not a regular occurrence. All staff received training in core values during their NVQ training. They discussed how they maintained people’s privacy and dignity on a day-to-day basis by, for example, carrying out personal care routines in private. A resident said, “I have privacy in my room if I want it, they always knock.” However, there were no blinds or privacy curtains in one of the bedrooms that faced onto a busy road. This was especially important as the person occupying the room spent time in bed during the day and was visible to anyone passing by. The administrator said this would be rectified. Care plans made reference to respecting privacy and maintaining dignity but did not always specify how this was to be achieved. During the course of the visit staff were seen to speak to people with respect. A relative said that staff always spoke well to people. A resident said staff were, “respectful.” Church View (Residential Home) Limited DS0000066410.V365687.R02.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Daily routines and meals suited the majority of people living at the home. Some people’s social and recreational needs were met through activities and contact with family and friends. EVIDENCE: There had been some improvement in the level of activities since the last inspection. The home employed a dedicated activities organiser for two afternoons a week. Their records showed they offered mainly ‘pamper’ sessions or reminiscence games. There was also a weekly exercise session run by an external therapist. There was conflicting information from care staff about what happened on the other days. Some said they provided activities every day others said they did occasionally and if they had time. There were no records of staff led activities. People living at the home had mixed views about activities. Church View (Residential Home) Limited DS0000066410.V365687.R02.S.doc Version 5.2 Page 16 Two people who returned surveys said that there were never any suitable activities. One wrote that they had received information about the home but thought there would be more stimulation for clients. At the time of the visit most people said they spent their time watching TV. One person said, “I don’t know about games or anything, as far as I know it is just the TV.” One relative commented that there were not as many activities as there used to be but staff did try. Another relative said, “There used to be things going on but not anymore, they are just sat.” Information in the annual quality assurance assessment (AQAA) indicated that the manager was going to make changes to the activities programme. People said that staff spent time with them. One said, “There is always someone having a chat” and another said, “it’s alright here, they talk to you.” A relative also said that staff went into her mother’s room to chat to her. There was some flexibility in the daily routine. For example, people were able to get up and go to bed when they wanted. One person said, “I felt a bit wobbly this morning, so I stayed in bed.” The daily notes for another person indicated that they liked to get up and dressed very early. Some routines were less flexible. For example, bathing routines, mealtimes and times for drinks were set, although one person said that they could ask for a brew at any time. Assessments included information about the person’s likes and dislikes and preferences for daily routines. Staff said they tried to give people as many choices about their daily lives as they were able. They said that if people were not able to make decisions then they used information on the care plans and also consulted relatives. On the day of the visit staff were heard consulting people, for example, about what they would like to drink. There were no set visiting times, which meant people could see their family and friends at any time. There was some contact with visitors from the local community, for example church visitors. Most care plans included information about people’s religion and whether they wished to continue to practise. The home did not have a rotating menu. The chef said that meals were planned with input from residents. The daily menu was on display outside the dining room. There was one set meal at lunchtime. The chef and staff said that people who were known to dislike what was on offer, or who asked for something else, were given an alternative. However, there were a number of people who would not be able to, or may not want to, request something different but who might like to be offered a choice. People had a list of choices at teatime. The chef said “they can have anything they want.” Most people said they liked the meals. One person said, “We get a proper dinner, a substantial meal with meat and vegetables and a pudding.” One resident wrote on their survey, “well prepared, tasty meals.” Other comments included, “the food is lovely you get more than enough,” and “very good food.” Church View (Residential Home) Limited DS0000066410.V365687.R02.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The complaints procedure ensured that formal complaints were investigated and acted upon. The lack of staff training and clear guidance in safeguarding adults could result in any incident of abuse being mismanaged. EVIDENCE: There was a complaints procedure in all bedrooms. This had been updated following a previous recommendation and included a timescale for the complaint to be resolved. People using the service and family carers indicated that they knew how to make a complaint. One relative commented, “If I have cause to comment on any issue, which is very rare, it has been dealt with as soon as possible.” Another said that they had only had minor complaints and they had been sorted out. Staff who returned surveys indicated that they knew how to respond if anyone raised concerns to them. The AQAA showed that the service had received two formal complaints in the past year and they had been resolved within the specified timescale. Church View (Residential Home) Limited DS0000066410.V365687.R02.S.doc Version 5.2 Page 18 There was a copy of the new safeguarding procedure for Lancashire. There was also a safeguarding procedure specific to the home, which directed staff to report any suspected or actual abuse to the manager. However, the procedure for senior staff was not completely clear and could result in staff misunderstanding their role in the investigation of any alleged incident. Although most staff had received some safeguarding training during their NVQ training, this had not been updated. Despite the lack of training, all staff spoken with were aware of their responsibilities to report any suspected or actual abuse to the manager. Senior staff would benefit from clearer guidance about their role should they be in charge of the home. The area manager had developed a training package and planned to undertake a ‘training the trainer’ course so that she could provide regular updates to staff. Church View (Residential Home) Limited DS0000066410.V365687.R02.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was clean and well maintained and the standard of décor and furnishings provided people with a comfortable and homely place to live. EVIDENCE: The home was generally well maintained. During a tour of the building a few areas that were in need of attention were identified and discussed with the administrator. For example, the flooring in one of the en-suite bathrooms needed replacing and the carpet in the main dining room needed repairing or replacing in order to reduce the risk of trips. Church View (Residential Home) Limited DS0000066410.V365687.R02.S.doc Version 5.2 Page 20 Despite a previous recommendation most of the windows in the bedrooms were ‘fogged’ because the seals on the double glazing units had not been replaced. This meant that the view from the window was obscured in many rooms. The décor and furnishings in communal areas were comfortable and homely. There were three lounges, which meant that people could choose where to sit. Several bedrooms had new furniture and had been redecorated. Others had been highlighted for redecoration in the near future. People said they liked their rooms. One person remarked that their bedroom was very comfortable and another said, “it is lovely and clean with everything I need, just like home.” At the time of the visit most of the home was clean and there were no offensive odours. The AQAA indicated that the manager had used the Department of Health guidance to assess the infection control systems within the home and there was an outstanding action plan, but this was not seen at the time of the inspection. The infection control guidance that was available to staff was out of date. Few of the staff had received infection control training. Some of the practices in the home increased the risk of spread of infection. For example, there were communal combs and tablet soap in one of the bathrooms. There was a separate laundry room that had sufficient equipment. The AQAA indicated that a dedicated laundry person had been appointed to minimise the risk of spread of infection via laundry. As recommended after the last inspection, there were gloves, hand wash and paper towels available for the laundry staff. There were no complaints about the laundry. One person said, “My laundry was sent yesterday and brought back today.” Church View (Residential Home) Limited DS0000066410.V365687.R02.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the home were protected by the recruitment practices. There were sufficient staff, with appropriate training, to meet the needs of people using the service. EVIDENCE: Staffing levels had recently been increased when it became apparent that the needs of several of the people using the service had increased. Most residents and staff who returned surveys indicated that there were usually enough staff on duty, although two relatives said that they could do with more staff. At the time of the visit staff themselves said the extra member of staff meant that they could meet people’s needs. Some people commented about their good relationships with the staff. One said, “The staff are very good, they never lose their temper even with difficult people.” Another said, “the staff are alright, they talk to you.” A relative described staff as, “kind and caring.” Church View (Residential Home) Limited DS0000066410.V365687.R02.S.doc Version 5.2 Page 22 The files of two new staff were seen. The files included all the necessary information and documents to show that the required pre-employment checks had been carried out. All employees received a contract of employment. Staff who completed surveys confirmed that they had to have pre-employment checks. One wrote, “just to make sure it was safe for me to work in this environment.” New staff went through an induction programme. There was an initial introduction to the home and the residents. Staff then went on to complete a workbook covering basic care skills. It was not clear whether the programme covered all of the essential topics in the Skills for Care common induction standards and whether staff would be able to use the workbook when they went on to do NVQ training. The training records showed that not everyone had received up to date training in the safe working practice topics. Some staff had received other training relevant to the needs of the people using the service. For example, dementia care awareness and sensory deprivation awareness. The area manager had enrolled with the Lancashire Workforce Development Programme and had identified appropriate courses and funding. The AQAA showed that over 50 of care staff were qualified to NVQ level 2 or above. Church View (Residential Home) Limited DS0000066410.V365687.R02.S.doc Version 5.2 Page 23 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 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Management and administration systems were not effective enough to ensure that the home was always run in the best interests of the people living there. EVIDENCE: The deputy manager was taking day-to-day charge of the home in the absence of the manager. At the time of the visit a senior carer was in charge. The management team were supported by the area manager and the registered provider who visited the home on a regular basis. Church View (Residential Home) Limited DS0000066410.V365687.R02.S.doc Version 5.2 Page 24 Staff who returned surveys indicated that they received support from the management. One wrote, “ they are always willing to listen and give advice no matter how small the problem or how busy they are.” The last customer care surveys were in July 2007. The results had not been collated or published. There was no development plan to show what the service hoped to achieve in the coming year. The business plan was not available. Staff said they were planning to hold residents’ meetings but none had been arranged at the time of the visit. There were regular staff meetings. Minutes of the previous meeting showed that issues affecting residents were discussed and actions were planned to improve outcomes for people using the service. Despite the AQAA indicating that policies and procedures had been reviewed, there were a number of old and out of date documents in the policy manual. The administrator acted as appointee for two people. Both people regularly returned some or all of their personal allowance for safekeeping but there were no accurate and complete records of this money. The lack of records meant it was not possible to check that the amounts were correct. The finances for other residents were managed by their family or a receiver. These residents had individual records of money handed over and spent on their behalf. Some of these were checked and the money held and the records were accurate. Receipts were not obtained for all expenditure. Staff received fire safety training twice a year and staff spoken with knew what to do in the event of fire. A full practice drill took place during the training and staff said that they had drills in between but there were no records of these. The fire procedure was on display in the home. Fire safety systems and equipment were serviced and tested on a regular basis. The AQAA showed that servicing and maintenance of other installations and equipment was up to date. Following a previous recommendation all portable electrical appliances were tested annually. Maintenance staff visually checked any equipment brought into the home between checks. Following a previous requirement risk assessments had been carried out for the use of caustic denture cleaner. These were not complete and did not give any indication of the level of risk for each individual. However, a member of staff said that denture cleaner was no longer left in any bedrooms. Church View (Residential Home) Limited DS0000066410.V365687.R02.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 3 3 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 4 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 2 X X 2 Church View (Residential Home) Limited DS0000066410.V365687.R02.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. 1. Standard OP7 Regulation 15(2) Timescale for action Care plans must be amended as 30/11/08 and when the person’s needs change so that staff have up to date and accurate directions about the care to be provided. Health care risk assessments 30/11/08 must be completed accurately and revised when the person’s needs change. When a health risk has been identified there must be a care plan in place to tell staff how to manage or reduce the risk. (Previous timescale of 31/10/07 not met.) In order to promote their health 31/08/08 and welfare people must be offered their medicines as their doctor prescribes them. In order to safeguard people 31/08/08 using the service, full and accurate records must be kept of any money deposited for safekeeping and any money spent on their behalf. Requirement 2. OP8 12(1)(a) (b) 3. OP9 13(2) 4. OP35 17(2) Schedule 4(9) Church View (Residential Home) Limited DS0000066410.V365687.R02.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. 2. 3. 4. Refer to Standard OP3 OP7 OP9 OP9 Good Practice Recommendations Staff should ensure that a thorough assessment takes place with anyone thinking of moving into the home and the information is available before the person moves in. All care plans should be person centred to ensure that staff have sufficient information about people’s individual needs and how they wish to be supported. Risk assessments for self medication should be reviewed more frequently and safety checks should be carried out and recorded as specified in the care plan. In order to reduce the risk of transcribing errors, handwritten entries on MAR charts should be signed and witnessed. When residents are prescribed either one or two tablets staff should indicate how many they have been given so that consistency is maintained. There should be records of the temperature of the storage area so that it can be seen that medications are stored correctly. There should be a regular programme of activities that are planned to meet the individual needs of people using the service. In order to give people a choice an alternative meal should be offered at lunchtime. The training for safeguarding adults should be delivered as soon as possible, to ensure that all staff are clear about their role in recognising and reporting abuse. Windows should be repaired or replaced so that residents’ view from these is not obscured. In order to minimise the risk of spread of infection: – Staff should receive training in infection control practices – Staff should have access to up to date guidance – The practice of using communal combs should cease. 5. 6. 7. 8. 9. OP12 OP15 OP18 OP19 OP26 Church View (Residential Home) Limited DS0000066410.V365687.R02.S.doc Version 5.2 Page 28 10. OP30 The planned programme of training in the safe working practice topics should be delivered as soon as possible in order to protect the health and safety of people living and working at the home. There should be systems to audit the quality of care provided at the home so that any deficiencies can be identified and acted upon. There should be an annual development plan that sets out the proposed development of the home for the next 12 months. The views of residents and relatives should be obtained on a regular basis so that these can be taken into consideration. Policies and procedures should be reviewed at regular intervals so that the information in them is current and accurate. Records should be kept of fire practice drills to help to identify any staff who need further training. 11. OP33 12. OP38 Church View (Residential Home) Limited DS0000066410.V365687.R02.S.doc Version 5.2 Page 29 Commission for Social Care Inspection North West Regional Contact Team Unit 1, 3rd Floor Tustin Court Port Way Preston PR2 2YQ 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. 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