Inspection on 07/04/09 for Church Walk House

This inspection was carried out on 7th April 2009.

CQC 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 Walk House 04/07/08

Church Walk House 29/05/07

Church Walk House 16/06/06

Church Walk House 08/12/05

Church Walk House 11/04/05

Church Walk House 06/10/04

Church Walk House 06/04/04

Extracts from inspection reports are licensed from CQC, this page was updated on 06/08/2009.

CARE HOMES FOR OLDER PEOPLE Church Walk House Church Walk Childs Hill London NW2 2TJ Lead Inspector Duncan Paterson Unannounced Inspection 7th & 8th April 2009 9:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Church Walk House DS0000010421.V374758.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. Church Walk House DS0000010421.V374758.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Church Walk House Address Church Walk Childs Hill London NW2 2TJ 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) 020 7794 2144 020 7794 2460 wayne@churchwalkhouse.org Hendon Old Peoples Housing Society Wayne Harry Hughes Care Home 42 Category(ies) of Dementia (0), Old age, not falling within any registration, with number other category (0) of places Church Walk House DS0000010421.V374758.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old Age, not falling within any other category - Code OP 2. Dementia - Code DE The maximum number of service users who can be accommodated is: 42 18th February 2009 Date of last inspection Brief Description of the Service: Church Walk House is registered to provide personal care and support for 42 older people who may also have dementia. The home is operated by a charitable organisation, the Hendon Old Peoples Society, which manages the home through a management committee. The accommodation is provided in a building that used to be the vicarage. The building is on three floors. In the basement is the kitchen and laundry. On the ground floor are the main lounge, dining room, smaller lounge and a number of bedrooms. On the first floor are the rest of the bedrooms, a quiet lounge and the offices. Six of the bedrooms are double and the rest are single. There are bathrooms and showers on both floors. There is a shaft lift. There is a large, attractive garden at the rear of the home. The staff team consists of a manager, a deputy manager, senior staff and a team of carers. There is also a team of ancillary staff including cleaners, cooks and laundry assistants. The fees are between £470 to £550 per week. Church Walk House DS0000010421.V374758.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This key inspection took place on 7th and 8th April 2009. It was carried out by the lead inspector who was accompanied on the first day by a specialist pharmacy inspector who inspected the medication arrangements. The inspection involved discussing care arrangements with the management team, staff, residents and visiting relatives. Care records were inspected as were a sample of the home’s records, procedures, policies and forms. The Annual Quality Assurance Assessment (AQAA) returned to us by the home, was taken into consideration. There has been a recent safeguarding investigation at this service. None of the allegations were upheld although the paper trails at the home were identified as insufficient. The local authority led safeguarding meetings and the service drew up an action plan setting out actions to develop the service. The meetings have now concluded as the matters have all been investigated and resolved. What the service does well: There are some very enthusiastic, caring staff amongst the staff team who are motivated to provide a good standard of care and a personalised service for residents. The service benefits from this and is good at creating a friendly, relaxed and pleasant atmosphere. There were some positive and friendly interactions observed between staff and residents. Many of the residents spoken with said they liked the home and the friendliness of staff. For example, one resident said you, “couldn’t beat this home”. Another resident said she “liked living here”. A number of relatives spoken with also praised the home. The new deputy manager is good at communicating with residents on an individual level and is able to work flexibly so that requests from residents are acted upon quickly. Staff like this approach and many made favourable comments about the deputy manager. Activity provision at this home has been good and well resourced. There is a full time activities co-ordinator as well as an activities volunteer who visits once a week. There are clear displays of information about activities including photographs of past events and information about future events. The activity Church Walk House DS0000010421.V374758.R01.S.doc Version 5.2 Page 6 organiser is currently away. This has had an impact but things should pick up again on her return. What has improved since the last inspection? What they could do better: There is still a lot of work required in order to raise standards. One essential area for development is that of recruiting permanent staff. Currently, because there has been a recent high level of staff turnover there is reliance on agency staff. This brings difficulties of having staff who do not know the home or the residents well. Such staff also need induction and briefings as to residents’ needs. The work to draw up new care plans for all residents is not yet complete and requires more input. Similarly, the recording of care provision, although much better and more systematic, still has some gaps which causes a lack of accountability. There is still some way to go in providing residents with dignity of care. Staff supervision will help with this but frequency of supervision also needs improvement. Night care provision has improved but further development is needed. A night supervisor has been appointed and a second one is to be appointed. However, a job description is needed for this post. Night managers are vital as the lack of staff monitoring at night led to problems in the past. In addition, manager’s night time monitoring checks need to be continued to make sure that care provided at night is safe and properly carried out. Staff training is required for the majority of staff. The service has planned training for staff for 2009 and this will greatly assist in developing staff skills. However, there is a current shortfall of staff trained in First Aid and this must be provided quickly. Staff in-fighting has been present at this service for some time and was a feature of the recent safeguarding investigation. There have been attempts to address the issue such as through the provision of staff development sessions in the summer of 2008. The new deputy manager has been successful in Church Walk House DS0000010421.V374758.R01.S.doc Version 5.2 Page 7 promoting good relations at the service. Many staff were complimentary of the way the deputy manager has introduced changes and worked with staff. Further development work in this area is required. One of the matters which the service was asked to address from the safeguarding investigation was to review laundry provision and provide name tags for items of residents clothing so that they did not get mixed up. This work has been started but is not yet complete. There is a shortfall of domestic staff available. One domestic worker was off sick during the inspection which meant that there was only one domestic worker, rather than two, available to clean the home. There is a further worker who works in the laundry. The domestic staff were spoken with and they advised that at weekends they only have one worker cleaning the home and completed laundry tasks. The deputy manager advised that the service was looking at appointing a domestic worker to wash up after meals. Currently, care staff do that. Such an appointment would be an improvement but a wider review of the domestic staffing and management arrangements is needed make sure that the home runs smoothly. The building has some charm but there is a need for maintenance in some areas as well as the need to keep parts of the home, such as the rubbish bins area, more clean and tidy. The building was converted for use as a care home many years ago and therefore the premises are not modern. Adaptations have been made but there is a limit to what can be done. There has been a recent occupational therapy assessment of the premises and recommendations were given as to how improvements could be made. For example, through better signage and provision of a storage area for wheelchairs, hoists and other pieces of equipment. At the time of the inspection a storage space for hoists and wheelchairs was being built and nearing completion. There is a need for the management committee to take on greater expertise and monitor the service in a more rigorous and informed manner. For example, there had been an attempt to manage the safeguarding matters internally without informing (as is required) us, or the relevant local authorities. A more responsive, advice seeking and consultative approach should have been taken. Another example is that of the monitoring of the home and the setting of targets or a business plan for the manager. Regular monitoring visits are made to the home but these need to focus more on the monitoring of care provision and development of the service. It may be useful to extend the expertise available on and to the management committee so that it can operate in a more informed manner. New people for the committee may be required and this should be reviewed and considered. Church Walk House DS0000010421.V374758.R01.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 Walk House DS0000010421.V374758.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Church Walk House DS0000010421.V374758.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 13&4 People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Once the planned work to review all care plans and provide staff with relevant training has been carried out the service will be in a much better and more informed position to meet residents’ needs. Information available for residents and relatives is now more comprehensive. EVIDENCE: The home’s statement of purpose has recently been updated and now has a section dedicated to providing information about the home’s aims and objectives as well as a section on equalities and diversity. These matters had been the subject of previous recommendations. Comprehensive details are provided in this document and it is a useful document for residents and others interested in the service. As will be described in more detail in the next section, the home has started a wide ranging review of each resident’s care plan. In addition, a number of residents have had recent reviews with social workers from the relevant Church Walk House DS0000010421.V374758.R01.S.doc Version 5.2 Page 11 funding authority. This should raise the standard of information held about each person and assist in clarity of staff actions required to meet people’s needs. Recent new monitoring tools, such as body maps and clearer staff recording initiatives, will also help. The majority of residents have their placements arranged through local authorities and details about people’s assessed needs are provided to the home. The work to review care plans is not yet complete and although, in some cases, there has been good progress in meetings people’s needs, further work is needed. There is also a need to provide staff with training and once this has been delivered the service will be in a much better position to provide residents with care to meet their needs. Church Walk House DS0000010421.V374758.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 & 10 People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents can be confident that there have been improvements to care plans, recording of care provision and providing residents with dignity of care. More work in these areas is needed to fully improve the service. More frequent auditing of medication is needed to make sure that standards are maintained. EVIDENCE: The recent safeguarding investigation highlighted a poor standard of recording at this service as well as poorly arranged care plans. Not all aspects of care provision and events affecting residents had been recorded. Staff handover written information was poor and night time care records were poor. Care plans in use were complex, difficult to follow and had information in a number of places rather than in one care plan for each person. In response to these issues there had been requirements given in the last inspection report of 18 February 2009 as well as from the safeguarding meting. Church Walk House DS0000010421.V374758.R01.S.doc Version 5.2 Page 13 The service has responded positively. An action plan to improve the service at the home has been drawn up with agreed timescales. There are action plans to improve night time care and recording of care as well as to re-write all care plans. New systems of staff recording have also been introduced. These new systems, when operating fully, should provide a much more accountable system for recording care. We were shown a sample of the new care plans. Nine had been completed at the time of the inspection. The new care plans are much easier to use and contain a great deal of information about each person. They have a much more person centred style and have been drawn up after intensive work and input from the manager and the deputy manager. There is also now much more focus on obtaining, and recording coherently, health care information about each resident. Some of these records, such as weight records, are held separately, but will transfer to the new care plans later. We looked at the recording of receipts, administration and disposal of medication and audited samples of stock to see if it was being given as prescribed. We observed medication being administered to two residents and noticed that the senior care worker explained what she was doing, what the medicines were for and gave it in a professional, encouraging manner. We noticed that the senior care worker did not always have the trolley keys with her during the medication round and that this could pose a risk to security if the trolley was left unlocked when unattended. The clinical room was tidy and well organised. Controlled drugs were secure and we found that the balances were correct and well recorded. We looked at the Medication Administration Records (MAR) and noticed that allergies were entered and receipts carried forward. This allows the home to maintain continuity of supplies and carry out audits. There were some omissions in the recording of administration particularly for one area of the home. One resident prescribed mainly liquid medicines had gaps at 12.30pm and 5.30pm on two occasions and we did not know if the medicines had been given. We noticed that there were gaps on the MAR at 8am and 5.30pm for two other residents in this unit. We audited several tablets including a complex dose of an anti-parkinsons drug and generally found balances to be correct. There was one discrepancy of an extra iron tablet left for one resident and we found tablets left in the monitored dosage system for three residents which had been recorded as given. We noticed a gap for calcium tablets on 6/4 and the tablets were still in the container. The home had good practices of keeping a copy of the original prescription with the MAR so we were able to reconcile the latter with the prescriber’s instructions. Recording of creams and other topical products was inconsistent Church Walk House DS0000010421.V374758.R01.S.doc Version 5.2 Page 14 and we were unable to gain sufficient evidence that they were always applied as prescribed. We looked at two care plans and read about the outcomes of doctor’s visits and hospital appointments. We looked at the home medication audits and noticed that they were only carried out monthly and were quite brief. The last one was carried out on 7/3/09. The manager told us that there had been several new staff members and that this might account for some of the issues we identified above. Overall therefore, we were reasonably satisfied, that the home was trying to maintain the previous good standards achieved in handling medication safely. However, to prevent error and raise standards more rigorous auditing is needed together with further training and assessments of competency. This is to ensure that at all times the health and welfare of the residents is maintained and they receive their medication as prescribed. There are some promising signs that progress is being made to provide care for residents that is dignified and respects people’s wishes and privacy. For example, there are a number of skilled and enthusiastic care staff who report that there have been improvements at the home. There was a pleasant atmosphere at the care home during the inspection with many residents giving us positive feedback. One resident said that the, “staff are very good”. There is also more sensitivity and awareness amongst the management team about providing dignified care to residents. However, further progress is needed so that residents can be sure that all staff are considered in their approach and provide a consistent standard. For example, one resident described help she had received in dressing. She described a situation where a staff member had chosen for her the first item of clothing to hand which was not what the resident wished to wear. Another example was of the serving of breakfast. The meal was not served until everyone was present which meant that a number of residents had been sitting waiting for a long time before they could eat. A third example was of the need to shift further some staff attitudes. One staff member described how staff had formerly, “sat around smoking”, rather than working. The staff member felt that this had improved but further development is needed to progress this. Some feedback was provided from staff and a visiting relative about concern over hygiene and how often people were given baths or showers. Church Walk House DS0000010421.V374758.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 & 15 People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Overall, activity provision is good but has suffered with the activities organiser being away. There is lots of community contact with relatives visiting often. Food is good but the serving of breakfast needs a review as residents currently wait a long time before they can eat. EVIDENCE: There is a full time activities co-ordinator as well as a volunteer who assists once a week with activity provision. There has been a history of very good activity provision and there was ample evidence of that seen. For example, there are numerous photographs of residents taking part in activities. There are notice boards with evidence of work residents had completed as well as details about forthcoming activities. At the time of the inspection the activities co-ordinator was away from the home. One resident pointed out an activities notice board and said the information on it was now,” out of date”. The activities provision should pick up when the co-ordinator returns. Church Walk House DS0000010421.V374758.R01.S.doc Version 5.2 Page 16 During the inspection staff were observed to be running activities including a quiz. One member of staff said that she regularly took residents out for trips such as shopping trips. Staff and volunteers from the Barnet Advocacy service were visiting during the inspection. There are relatives visiting each day and a number of these were spoken with during the inspection. The majority of people spoken with were happy about the home and the service provided. One relative said she found the home good and that, “staff can provide my relative with what she wants”. Another relative said, “they do their best”. The food served is good. The care home has been awarded 5 stars from the London Borough of Barnet in their environmental health inspection under their “Scores on the Doors” scheme. 5 stars is the top rating possible. Mealtimes were observed including lunch and breakfast. There is a choice for residents and meals are taken in the dining room. The dining room is a bright attractive room with a number of tables where residents can sit in small groups. A small number of residents eat in the main lounge and a smaller group in the small lounge. Staff assist some residents to eat. As already noted, the arrangements for breakfast are that the meal is not served until everyone is ready. This meant that on both days of the inspection breakfast was not started until approximately 10am. The kitchen staff said that breakfast was ready for serving before this and the deputy manager felt that there was no need to wait for everyone to get to the tables. The length of waiting meant that some residents were waiting a long time to eat and breakfast also became mixed up with the GP visit which took place at the same time. This resulted in some residents, who were already seated waiting for breakfast, being asked to get up to see the GP. The serving of breakfast and timings need to be reviewed. Lunch was a much more straightforward operation. Church Walk House DS0000010421.V374758.R01.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 & 18 People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Safeguarding arrangements at this service have not been good. Revising the safeguarding adults policy and agreeing an action plan for overall improvement have been positive steps forward. However, more work is needed to provide staff with relevant training and to make sure that everyone understands and works within the safeguarding policy and procedure. EVIDENCE: The complaints records were inspected. There have been 14 complaints since the last key inspection of 4 July 2008. Some of these complaints relate to safeguarding matters which were also addressed in the recent safeguarding investigation. A number of complaints involve missing clothes and staff attitude. There was evidence that the matters had been responded to with letters sent to people who had complained. The issues raised by the complaints are matters which the service is addressing, such as through the laundry review and the move to address quality of care and providing residents with dignity of care. There has also been a recent relatives and residents meeting which has allowed discussion of such issues. A communication book for relatives to raise arising issues has been started. The recent safeguarding investigation has been described. This work is ongoing with the service working to meet it’s own action plan as well as arising actions from the safeguarding meetings. Of specific relevance here is that the service has recently updated the safeguarding adults policy. This now clearly Church Walk House DS0000010421.V374758.R01.S.doc Version 5.2 Page 18 describes the role the service has in reporting safeguarding matters to the local authority. Not reporting safeguarding matters to the local authority or to us was a feature of the recent safeguarding matters and any future arising matters will need to be handled carefully with advice sought if needed. Staff will also need further training to make sure that they understand the home’s policies and procedures in this area as well as the wider issues of elder abuse and dignity of care for residents. A requirement is given that those staff who have not received safeguarding adults training or dignity of care training must now be provided with it. Church Walk House DS0000010421.V374758.R01.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 - 26 People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. There are pleasant aspects and features of this now aging building. However, there is a need to make some repairs and improvements as well as consider how the building can be improved in line with a recent occupational therapy report. The work to improve the housekeeping arrangements is not yet complete and this is still affecting residents’ quality of life. EVIDENCE: The home was not purpose built and is a mixture of an old converted building with a 1950s extension. This has lead to a home which has retained some pleasant features and charm, such as the high ceilings and large windows of the old vicarage building. In addition, the bedrooms in the extension all face the garden providing residents with pleasant views and a peaceful aspect. There is a large attractive garden. However, there are also some confined spaces, some slopes, some old style toilets and bathrooms and a lack of storage space for wheelchairs and other equipment. The storage space issue is Church Walk House DS0000010421.V374758.R01.S.doc Version 5.2 Page 20 being addressed with the building of a storage space for hoists and wheelchairs. A tour of the home was carried out with some bedrooms visited. The bedrooms are relatively small but provide simple, homely living space for residents. Many residents have personalised their rooms and created attractive welcoming rooms. However, there is a need for some renewal and redecoration throughout the home. Work was in progress to renovate one bedroom. The patio area outside the dining room was an example where renovation work is needed. During the inspection the dining room door was seen to be wedged open with a chair and the path from this door along the patio was cluttered with chairs and a frame. Simple steps could be taken to make the outdoor of the home more appealing for residents and easier to use. This is particularly important as the garden is large and attractive with plenty of scope for residents to use and to sit out in fine weather. The area at the front of the home where the rubbish bins and clinical waste bins are kept was not very tidy. There was a drain that was overflowing as well as a greasy, oily surface which presented a hazard to anyone using this space. This must be cleared up. There has been a recent Occupational Therapy report and this was seen. A number of recommendations were made in this report including the need for more signage. The management committee should consider carrying out the recommendations of this report. The need to provide residents with keys to their bedrooms was discussed with the deputy manager. This had been a requirement given at the last inspection. The deputy manager advised that this is being addressed through use of a specific form on resident’s case files. However, the work is not yet fully complete and one resident said she had no key to her bedroom but wished one. This requirement is repeated with a new timescale. This inspection has identified that there is still a problem with the housekeeping arrangements. There had been problems with providing bedding for residents as well as with the laundry and providing the correct clothes to residents. Although there have been some improvements in these areas the communication between the housekeeping staff and the manager can be improved. The requirement to review the housekeeping arrangements given at the last inspection is repeated in this report. A report of the review should be produced and ideally the review should be carried out by the management committee or an external person. Church Walk House DS0000010421.V374758.R01.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 & 30 People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The service to residents is being negatively affected by a reliance on agency staff, a lack of staff induction and training and a lack of staff supervision. Steps have been taken to improve matters and this has had some success. However, further work is needed to make sure that residents receive a better overall service. EVIDENCE: The recent safeguarding investigation has meant a certain amount of upheaval and turnover to the staffing team. Currently, a number of staff are working long hours each week and there is a reliance on agency staff. The manager reported after the inspection that staff hours were being reduced and that progress had been made with staff recruitment. This needs to be completed as soon as possible so as to bring consistency to the staff team. Night care was a particular problem identified by the safeguarding investigation. Progress has been made to address this matter. Since the last inspection of 18 February 2009 the staffing levels have been increased to four staff at night. Further, a night manager has been appointed and steps taken to appoint a second night manager. The manager and deputy have completed night monitoring visits and new night care recording tools have been introduced. This has lead to an improvement. However, the overall weaknesses in staffing at the home still affect night care and these must be Church Walk House DS0000010421.V374758.R01.S.doc Version 5.2 Page 22 addressed quickly. These include the fact that the night managers have no job description, that night staff have not had first aid training, that staff are not being supervised regularly and that agency staff are routinely being used to provide night cover. The safeguarding investigation has also found that there have been some gaps in the recording of care provision. Requirements are given about all these matters. One domestic worker was off sick during the inspection which meant that there was only one domestic worker, rather than two, available to clean the home. There is a further worker who works in the laundry. At weekends, the domestic staff report, there is only one worker both to clean the home and complete laundry tasks. The deputy manager advised that the service was looking at appointing a domestic worker to wash up after meals. Such an appointment would be an improvement but a wider review of the domestic staffing and management arrangements is needed make sure that the home runs smoothly. One relatively new staff member’s file was seen. There were no records of a staff induction. The manager confirmed that there had not been an induction. Induction for new staff must be provided and this must be extended to include an induction for agency staff. The safeguarding investigation found a need for agency staff to be inducted and briefed about residents needs. Five staff files were checked in order to assess the recruitment procedures. Generally, there was evidence that recruitment is carried out thoroughly. However, there was a gap in some cases in obtaining information about people’s right to work in the UK. These checks must be carried out. As part of the home’s action plan drawn up after the safeguarding investigation the manager produced a staff training matrix. This sets out each member of staff and details the training they have received. The matrix provides evidence that the majority of staff need training in a number of areas including manual handling and first aid. The home’s action plan has set out a timescale of when staff are to receive this training. Again, a requirement about this is given to make sure that the training is provided as planned. Church Walk House DS0000010421.V374758.R01.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 32 33 35 36 & 38 People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The management committee needs to focus more on monitoring the quality of care provided. Staff are not being provided with regular supervision which affects the quality of the service provided. Consideration needs to be given to adopting health and safety recommendations. EVIDENCE: The manager has recently started the Leadership and Management in Care Services Award. This should provide benefits for the manager as well as the overall service. This inspection has identified the need for the management committee to be more robust in the monitoring of the home and to focus on assisting the manager and staff to provide a quality service based on the needs of residents. Church Walk House DS0000010421.V374758.R01.S.doc Version 5.2 Page 24 The regular monitoring visits carried out by the management committee (known as Regulation 26 visits) were inspected. These visits are carried out regularly and are completed on specific forms. However, they need to dwell more on assessing the quality of the care provided and identifying how the service can improve. It may assist to draw up a business plan for the service with specific care objectives so that reference to these can be made in the monitoring visits. This could also be used in supervision, support and monitoring of the home manager. The management committee had initially worked to address the safeguarding matters internally. This did not work and runs against the agreed local safeguarding procedures as well as care home legislation. A more open, advice-seeking approach needs to be taken by the management committee. Extending the expertise of management committee members may be a useful way of developing the expertise of the overall management committee. The quality assurance initiatives will benefit from some development. An annual survey is carried out, there are regular monitoring checks and there are meetings with relatives and residents. However, the safeguarding investigation highlighted a great deal of information about how residents experience life at the home which had not all been identified by the manager or the management committee. For example, a great deal of feedback was obtained about how the laundering of clothes was managed as well as how residents were experiencing night care. This would be very useful for the service if it had been obtained through quality assurance initiatives. Ways should be sought to obtain year round feedback from residents, relatives and others which can be used to improve the service. The arrangements looking after residents money was discussed with the home’s administrator. This is a relatively straightforward system with money looked after for a small amount of people within a residents’ account. A sample of staff supervision records were looked at. No recent supervision had been provided for staff. The manager said that this had lapsed recently. However, since the inspection the manager said that staff supervision had restarted. This is an important area where staff can be monitored in their work. It must be carried out regularly and a requirement is given about it. Maintenance certificates for the home were inspected. These had been regularly carried out. A recent health and safety audit of the home was seen which had been carried out by an external consultant. This audit contained some recommendations about the service to improve health and safety. Consideration should be given to adopting these recommendations. Church Walk House DS0000010421.V374758.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 3 X 3 2 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 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 3 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 X 3 2 X 3 Church Walk House DS0000010421.V374758.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. 1. Standard OP27 Regulation Requirement Timescale for action 01/07/09 2. OP24 3. OP7 4. OP9 16(2)(c)(e The housekeeping arrangements ) must be reviewed with improvements made, where indicated, to the safe handling of residents clothes, residents bedding and laundry arrangements. Clear lines of responsibility must be drawn up. This requirement is re-stated from the last inspection. 23(2)(e) Review the bedroom key holding arrangements for residents, providing keys where requested and recording outcomes on care plans. This requirement is re-stated from the last inspection. 15 Introduce a new easier to use care planning system. This requirement is re-stated from the last inspection. 13(2) Attention must be given to the accurate recording of administration on the medication Administration Records. There must be no gaps. If medicines are not administered then the correct endorsements must be used. Attention must be also be DS0000010421.V374758.R01.S.doc 01/07/09 01/07/09 15/05/09 Church Walk House Version 5.2 Page 27 5 OP9 13(2) 6 OP9 13(2) 7 OP7 17 8 OP18 18 9 10 11 12 13 OP19 OP19 OP27 OP30 OP30 23(2)(b) 23(2)(b) 18 18 18 14 OP29 19 Sch 2 15 OP30 18 16 OP31 26 given to the recording of creams and other topical products. There must be more robust auditing of medication to ensure accuracy in recording and administration and to provide evidence that medication is being administered as prescribed. There must be further training and assessments in competency to safely handle medication. This is to ensure that all staff are trained to the same level. Care provision must be fully recorded with checks made by senior staff at the end of each shift. Provide staff, who have not so far received it, with training on safeguarding adults and dignity of care. Clear, make safe and renovate the rear patio area. Clear, make safe and remove the slip hazard from the front rubbish storage area. Provide night managers with a job description. Provide staff with first aid training. Provide new staff with induction training and agency staff with an induction and a briefing about residents’ needs. Make sure that details about people’s right to work in the UK is obtained before they are offered work at the home. Provide staff with training in the following areas: • Manual handling • Dementia care The management committee to carry out Regulation 26 visits in more depth, checking the quality of care provided and identifying DS0000010421.V374758.R01.S.doc 15/05/09 01/07/09 15/05/09 01/07/09 15/05/09 15/05/09 15/05/09 01/06/09 15/05/09 15/05/09 01/07/09 01/06/09 Church Walk House Version 5.2 Page 28 17 OP27 18 18 OP36 18 how the service can improve. Carry out a review of the domestic staffing and management arrangements providing additional staff as indicated. Provide staff with regular supervision. 15/05/09 15/05/09 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 5 6 7 Refer to Standard OP10 OP15 OP31 OP31 OP33 OP38 OP9 Good Practice Recommendations Continue to support, motivate and encourage staff to provide person centred care that respects people’s dignity and privacy. Review the timings for and the serving of breakfast. Draw up a business plan for the service setting out areas for development and goals for the manager and staff. Consider appointing new members of the management committee in order to widen the skills and expertise available. Extend the quality assurance initiatives in use in order to obtain more direct feedback from residents, relatives and others. Carry out the recommendations from the Occupational Therapy and Health and Safety audits of the home. Review the home’s key policy so that medicines are stored safely at all times. Church Walk House DS0000010421.V374758.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Church Walk House DS0000010421.V374758.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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