Inspection on 16/06/08 for Churchill House

This inspection was carried out on 16th June 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Churchill House 30 Denmark Road Exeter Devon EX1 1SE Lead Inspector Ms Rachel Fleet Unannounced Inspection 16th June 2008 9.15 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 Churchill House DS0000071054.V366421.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. Churchill House DS0000071054.V366421.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Churchill House Address 30 Denmark Road Exeter Devon EX1 1SE 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) 01392 686490 01392 256193 churchill.house@guinness.org.uk Guinness Care and Support Ltd Mr Michael Sharland Care Home 11 Category(ies) of Old age, not falling within any other category registration, with number (11) of places Churchill House DS0000071054.V366421.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 either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP). 2. The maximum number of service users who can be accommodated is 11. N/A Date of last inspection Brief Description of the Service: Churchill House has existed for several years under other ownership. The previous provider recently joined with another organisation, forming ‘Guinness Care and Support Ltd.’, who now owns the home. The home provides personal care and accommodation to eleven people over retirement age. There are no awake night staff, and therefore the home is not suitable for anyone requiring personal support regularly at night. It cannot provide nursing care other than that which the community nursing service can provide, and does not offer intermediate care. The home is a four-storey, detached property, in a residential area of Exeter. Nine of 11 bedrooms have en suite facilities, several including baths. Bedrooms are on the lower ground floor, ground floor and first floor, with passenger lift access between these floors. The lounge-diner is on the ground floor. A small but very pleasant rear garden is accessed from the lower ground floor. There is no on site parking, with time-limited roadside parking in the vicinity. Local shops and GP Surgeries are near the home, with city centre amenities also relatively close. The latest Commission for Social Care Inspection (‘CSCI’) report for the home is pinned to the notice board in the entrance hall. Weekly fees for the home range from £300 to £500, depending on the room size, peoples’ care needs, and whether individuals are privately or Social Churchill House DS0000071054.V366421.R01.S.doc Version 5.2 Page 5 Services funded. These do not include newspapers, chiropody, hairdressing, toiletries, some continence products, transport and some activities. However, the last two may be subsidised by the home’s Residents’ amenities fund. Churchill House DS0000071054.V366421.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This inspection took place as part of our usual inspection programme. There were ten people living at the home on the day of our unannounced visit to the home, which took place over eight hours on a weekday. Mr Mike Sharland, registered manager, had previously returned a CSCI questionnaire about the home (the Annual Quality Assurance Assessment, or ‘AQAA’). This included their assessment of what they do well and their plans for improvement, as well as information about the people living at the home, staffing, policies in place, and maintenance/servicing of facilities. We had also sent surveys to the home for them to give to the people living there, their relatives/supporters, and to staff. We received eight back from people living at the home (six having been helped by staff to complete them), five from their relatives/supporters, and six from staff. We also sent surveys to three community-based professionals supporting people at the home, and received two back. Responses were positive rather than negative – the great majority being ‘Yes/Always’ or ‘Usually’. We met everyone who lived at the home, and six gave us their views in more detail. We found out from them what it was like living at the home, and also did this through observations, talking with two visitors as well as three care staff, and looking around the home. We also spoke with the manager. We looked in more depth at the care of three people living at the home, by reading their care records and related information (personal monies records, etc.), and checking how their medication was managed. We met with them, spoke to staff about their care, and looked at the accommodation in relation to their needs. Staff recruitment and training files, quality assurance information and records relating to health and safety – such as accident and maintenance records were seen. We ended the visit by discussing our findings with the manager. Information included in this report is from these sources and from communication with or about the service since our last inspection. Churchill House DS0000071054.V366421.R01.S.doc Version 5.2 Page 7 What the service does well: There were no negative comments on any surveys we received, and several were extremely positive about the home. Comments from relatives, other supporters or advocates of people who live at the home included: ‘Small, warm and friendly home that provides one to one care.’ ‘Staff seem to go to a lot of trouble to make X’s life as happy as possible, to be aware of any problems and extend affectionate care and help. X entered Churchill House in a distressed and poor state, and is now happy, laughing and confident, in their care.’ ‘They create a happy and comfortable living environment. Residents’ wellbeing seems a high priority at the home.’ A professional commented, ‘During my recent visit, I saw very good interaction between care staff and residents. Residents I spoke with were very complimentary of the home. Activities are arranged around residents’ choice, one-to-one. Staff are very attentive towards residents.’ Another said, ‘Basic care needs are very well provided for e.g. drinks, meals, etc. Emotional care was supported very well when a person was very anxious and vulnerable.’ Churchill House is well managed and run in the best interests of those who live there. It is a comfortable, clean and homely place for people to live. There are good admission procedures, which means that people are assured that their care needs can be met if they move into the home. Care planning systems and multidisciplinary working with other professionals ensures all aspects of care are monitored and peoples’ diverse needs are met. People have daily lives that satisfy their social, recreational and faith needs as individuals. They are treated very much as individuals, with dignity and respect. Links with visitors and the community are good, further enriching their lives. They enjoy a varied, balanced diet that meets their needs and preferences. The home has an effective complaints procedure, which people are confident in. It uses various safeguarding strategies to protect people from abuse. Staffing arrangements are satisfactory, ensuring peoples’ current needs are met. Churchill House DS0000071054.V366421.R01.S.doc Version 5.2 Page 8 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Churchill House DS0000071054.V366421.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 Churchill House DS0000071054.V366421.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3. (The home does not provide intermediate care – St.6). Quality in this outcome area is good. There are good admission procedures, which means that people who move into the home are assured that their identified care needs can be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: One person’s relative told us they got information about the home through previously living near the home, having a respite stay at the home, and through knowing someone who worked for the provider who could tell them about the home. Another said they had viewed a room before moving in to it, whilst a third said they had visited for lunch and tea before deciding to live there. We looked at the information provided to prospective residents or their families. This can be provided in large print on request, and was helpfully Churchill House DS0000071054.V366421.R01.S.doc Version 5.2 Page 11 supplemented by photographs of the home and home life. The manager agreed to add more detail about night care arrangements. Comments from a social care professional included, ‘I have to approach homes regarding all differing needs. Churchill House staff will listen and consider a person’s needs to establish the appropriateness of placement. It is much appreciated.’ A senior carer told us that they or other seniors visited prospective residents to assess their needs. The person was invited to visit the home and have a meal there, and their needs were further assessed during this visit. Staff also tried to get information about the person’s background or their ‘life story’, from the person themselves or their family. We saw full pre-admission assessments for people we case-tracked, including their approximate weights, spiritual needs, medication arrangements (if they wanted to be self-medicating, for example). Care staff told us they were informed in advance by the manager or senior carers about the care needs of people due to move in. Records for one person stated they had come for a trial stay. Churchill House DS0000071054.V366421.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 – 10. Quality in this outcome area is good. People living at the home are treated with dignity and respect. There is a person-centred care planning system that provides staff with information they need to meet peoples’ needs. Health needs are met through good multidisciplinary working with other professionals where necessary, although some unsafe medication practices create risks to people’s welfare. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Some people said their care plan had been discussed with them, with one describing how it could be ‘revised and added to’ if their needs changed. They also knew staff wrote a daily report for everyone, which also included any visitors they might have had. People felt the staff knew their needs. A visitor said, ‘Needs excellently well seen to, care is good, staff make X feel very “at home” here...She says she’s never been happier.’ Churchill House DS0000071054.V366421.R01.S.doc Version 5.2 Page 13 We saw detailed, person-centred care plans, personal histories, and risk assessments had been recorded for each person. Care plans had been evaluated at least monthly, in meaningful ways that reflected peoples’ moods, physical health, participation in social events/activities, etc. Care records included peoples’ daily routine, with variations on specific days of the week that reflected their interests, etc. A questionnaire had been completed with everyone, with varied questions such as ‘What is your happiest memory? How independent do you like to be? What has changed since you came into care? Are the changes better or worse? Are you able to follow your spiritual beliefs?’ We saw from care records that peoples’ nutrition and risks to them of getting pressure sores, etc. were reviewed regularly using specific risk assessments. People living at the home said staff soon noticed if they were unwell, or listened if they said they felt unwell. A visitor felt their relative’s health needs were well attended to. The home has a visiting dentist and visiting optician. One person told us the district nurse visited them. Some told us their weight was monitored, as we saw from care records. And also that they were helped to get to health appointments, with staff accompanying them. More able people told us they saw staff were polite and attentive to less able residents. People we asked were happy that staff administered their medication for them. Care records included signed consent forms, agreeing staff could do this. A blister-packed medication system, provided by a pharmacy, is used at the home. Staff described safe procedures for giving out medicines and we saw these were followed, during our visit. However, some tablets were loose in the medicine trolley, and not stored in the original box from the pharmacy. This was unsafe, because it was not clear what or whose tablets they were. One item had been dispensed in a bottle from the pharmacy (rather than the manufacturer’s packaging) more than a year ago. This was over the recommended storage limit for items provided in this way. Controlled drug storage facilities were not of the currently required construction. There were records of medication received into the home and medication returned to the pharmacy for disposal. Correct disposal systems were in place for used controlled drug patches, although they needed to be returned to the pharmacy in a more timely way. One person was self-medicating in that the home obtained their medication then handed it over to them. A risk assessment had been recorded. However, no record had been kept when medication was handed to the person, to confirm this (with relevant details) had taken place. Churchill House DS0000071054.V366421.R01.S.doc Version 5.2 Page 14 The manager agreed these medication issues would be addressed as a matter of urgency. One person had their own kettle in their bedroom, with longlife milk portions provided by the home. They appreciated how the home respected their privacy in this and other ways. There was a cordless phone people could use, for example. There were privacy locks on the bathroom doors. People living at the home told us staff always knocked on the door before entering, and told people they would be going into their bedroom if it seemed the person was not going to be there at the time. They thought staff were respectful, and said staff didn’t talk to them about other residents. Asked whether the home respects individuals’ privacy and dignity, a social care professional commented, ‘This has been very evident in my working with Churchill House team.’ A male resident said they didn’t mind being helped with personal care by female staff, although they couldn’t remember if the staff had asked them about this. Churchill House DS0000071054.V366421.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 – 15. Quality in this outcome area is good. People are enabled to have daily lives that satisfy their social, recreational and faith needs as individuals. Links with visitors and the community are good, further enriching peoples’ lives. They enjoy a varied, balanced diet that meets their needs and preferences. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Surveys from four people living at the home said there were always or usually activities arranged by the home that they could join in with; one answered ‘sometimes.’ Responses showed they really enjoyed the opportunity to go shopping. They were regularly taken on a one-to-one basis by staff, who pushed them in their wheelchair if needed. A visitor confirmed that their relative benefited from these outings. Three people said they weren’t interested in the activities arranged by the home, two saying they occupied themselves or took themselves out. There is a small library in the entrance hall. One person was doing jigsaws in a place set aside for them to do this. The only suggestions for improving the home were Churchill House DS0000071054.V366421.R01.S.doc Version 5.2 Page 16 two related to leisure, from staff – more joint activities possible, and short breaks for residents. During our visit, one person told us they sometimes went out on their own to local events. Others said they had been taken out to Devon County show, to local theatres, and on a one-to-one basis. One person said they were hopeful that they would soon be able to go on more outings further afield. The manager is currently trying to arrange an authorised driver for the home, so people can be taken on minibus outings using hired community transport. The home raises funds in various ways for the residents’ amenities fund, to subsidise events and activities. Two visitors said there was good communication by the home. One person living at the home said their friends visited freely and could have a meal at the home with them. A weekly church service is held at the home, which anyone is welcome to attend. We saw some care plans included that staff should offer choices ‘at the time’, avoiding assumptions about what people might want and ensuring people were regularly made aware of the options available to them. One person we spoke with had used advocacy information available in the entrance hall. A visitor’s survey, responding to whether the home supports people to live the life they choose, said, ‘Staff are very good in arranging outings, fulfilling errands, sorting out transport, etc. Personal and general cleanliness are excellently maintained.’ Staff told us that one resident uses the laundry room to do her laundry herself. There are portable pendant call bells, so people can get staff attention if using the garden, etc. People living at the home and a visitor who sometimes ate at the home described the food as ‘good’ or ‘very good’. Peoples’ dietary preferences were listed in the kitchen, and people confirmed staff knew their preferences. We heard people being offered choices at lunchtime. One person said they got lots of fresh vegetables and fruit; another told us they enjoyed a salad regularly, and colourful salads were served at lunchtime during our visit. Someone told us they particularly liked the midweek and Sunday buffet teas. Most people had their breakfast brought on a tray to their bedroom. We found one person in their bedroom had fallen asleep during their lunch. Staff went to see them as soon as we made them aware of this, their meal having gone cold. Staff told us fruit and biscuits were always available, and that people could have a packed lunch if they were going out for the day. The cook told us one person made their own snacks. Churchill House DS0000071054.V366421.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. Quality in this outcome area is good. The home has an effective complaints procedure, which people are confident in. It uses various safeguarding strategies to protect people from abuse, although some outdated written policies create a risk that appropriate action may not be taken in some situations. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A visitor said staff were always available to listen to any concerns or complaints. Surveys from visitors to people at the home, when asked if the home had responded appropriately if they raised concerns, said ‘Always’ or that they hadn’t had to raise concerns, with one adding, ‘Staff are aware of needs, ‘down days’, etc. and are responsive.’ The manager told us, and people confirmed, that he speaks with individuals every day to see if they have any concerns. People said that they could talk to staff and the manager about anything including complaints, and they would sort out any problems. Staff said they would direct people to senior carers or the manager if they had a complaint, or report the matter on their behalf. The complaints procedure was displayed on the notice board at the entrance to the home. There is also a book in the hall, next to the visitors’ signing in book, Churchill House DS0000071054.V366421.R01.S.doc Version 5.2 Page 18 where suggestions for improvements can be written as well as compliments. There had been no entries since 2007, and the most recent entries were positive comments about the care provided. The manager and staff had a good knowledge of safeguarding procedures, and had had training updates in the last year. They said they would report suspicions or concerns to senior staff within the home or within GCS Ltd., and also knew some of the external agencies that any concerns could be reported to if necessary. As with other GCS Ltd. homes, the safeguarding policies need clarifying and updating, since there is misleading guidance for staff suggesting they should investigate allegations. The manager was aware this would not usually be done unless indicated through multidisciplinary safeguarding decision-making. The policy on gifts to staff was displayed in the home’s entrance hall. We found inventories had been made of peoples’ property. Churchill House DS0000071054.V366421.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. Quality in this outcome area is good. The environment is of a good standard, providing people with a clean, generally safe, comfortable and homely place to live. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People we asked said they were satisfied with their accommodation, and confirmed their bedroom had sufficient warmth, hot water, ventilation and light, including in the evening. A visitor said their relative had a nice, large en suite bathroom. Some people were particularly pleased to have been able to bring their own furniture. Bedrooms we looked at were very different in size/shape, as well as reflecting the individuality of the occupant. Each bedroom has a door lock, enabling people to ensure their privacy if they wish. Churchill House DS0000071054.V366421.R01.S.doc Version 5.2 Page 20 We saw raised toilet seats or surrounding frames, to aid people’s independence. A bathroom sink was suitable for people using a wheelchair. There was also a high ‘perching’ stool to assist others, and a shower facility over a bath. People said the lift worked well. A visitor described the home as ‘very comfortable’, and said they were not aware of anything unsafe or any hazards. People living at the home, who we asked, also felt it was a safe environment, that minor repairs were attended to quickly, and there were enough adaptations. The home looked well maintained, with the manager carrying out repairs, maintenance, and interior decorating. We noted a variety of colours have been used, giving a more homely feel than on our previous visits. The communal areas of the home were bright and airy, with furnishings and fittings of a good quality. Chairs in the lounge were of different heights, to suit people’s different needs. The garden was easily accessible, though the manager was currently taking action to ensure there was completely level access for the better comfort of people going out in wheelchairs. People told us that they enjoyed using it, and praised the manager for all the extra time he had spent getting the garden to its pleasant state; one person living at the home enjoyed helping with the gardening. Garden furniture was out, with a new sunshade recently obtained. All areas of the home generally looked clean and there were no unpleasant odours. People living at the home who we asked were satisfied with the usual level of cleanliness. One told us some carpets had been steam-cleaned recently. We saw one area under bedroom furniture looked in need of attention; the person whose room it was said the furniture was moved once a week for more thorough cleaning. Staff confirmed there were disposable gloves and aprons for them to use, although cloth tabards were also used. They also had special bags for carrying soiled laundry straight to the washing machine, without the need to hand sluice items first (thus avoiding risk of cross-infection). The laundry room had handwashing facilities. The washing machine had recommended programmes for through cleaning of laundry. Churchill House DS0000071054.V366421.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 – 30. Quality in this outcome area is good. Recruitment procedures are sufficient, with just one aspect needing more attention to fully ensure people living at the home are protected from unsuitable staff. Staffing arrangements are satisfactory, ensuring peoples’ current needs are met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: One visitor described staff as ‘very patient’. Another – when asked if staff have the right skills and experience - said, ‘Skills seem good, added to which the residents are treated with kindness and care. Staff introduce a bit of fun where possible, which is excellent.’ During our visit, we saw there was a friendly, respectful relationship between the people living at the home and the staff. Another visitor thought staffing levels were appropriate, and described the atmosphere at the home as ‘a very happy family.’ One added staff were very, very helpful, and had been impressed that they had visited their relative when they were hospitalised. Someone living at the home said, “The staff go the extra mile to make it a happy home.” When we arrived the manager was on duty, with a cook who also worked some hours as a senior carer, and two other carers to look after 10 people. These Churchill House DS0000071054.V366421.R01.S.doc Version 5.2 Page 22 staff were also responsible for cleaning and laundry duties as necessary. There were only two carers later in the day, with the support of a cook over teatime, and two sleeping staff after 10pm. Staff confirmed a majority of the current residents were fairly independent and did not need daily help with personal care. They felt there were safe staffing levels day and night, and said staff were paid overtime as escorts on outings, to enable these to take place. One person felt awkward if they stayed out after 10pm, since they had to ring to be let in and felt this disturbed the night staff. When asked about night staffing arrangements (i.e. two sleeping staff), staff told us it was no problem to them if someone wanted to stay out late in the evening. People we spoke with said staff quickly and readily came to assist them if they felt unwell during the night, or had unexpectedly wanted help. The manager said he would reassure people about this, and discuss again whether anyone wanted a front door key. A staff member employed for a year explained the recruitment procedure they went through, describing a thorough process. This included meeting the people living at the home when they came for interview, and that a full police check was obtained before they began working at the home. We checked files for three staff employed in the last year. Required information had been obtained except that there was one unexplained gap in the employment history of one care assistant. An initial police check and two references, including one from their most recent employer, had been obtained for each, before they started working at the home One staff member confirmed they had worked with other staff initially before having their own practice observed by senior staff, when they were new. The home’s induction programme met accredited standards. Staff told us there were staff meetings every other month. Staff files included their supervision records; staff confirmed they found the supervision sessions useful, and said they could discuss training or any concerns they might have. The AQAA showed that four of the seven staff had a care qualification, one carer recently achieving a particularly high level (an NVQ4 in Health & Social Care). One staff member told us four were currently working towards a recognised care qualification. The manager is qualified to be an assessor for the course. Staff reported they had had health and safety updates in various topics in the last year. However, they had not had any specific training recently on the needs of people likely to use the service. Besides learning through the care course some were undertaking, the manager told us he would request training Churchill House DS0000071054.V366421.R01.S.doc Version 5.2 Page 23 (through GCS Ltd.) if a special need arose. Staff surveys reflected this, one saying, ‘If there is an area where staff are unsure, relevant training is offered.’ Churchill House DS0000071054.V366421.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38. Quality in this outcome area is good. The home is run in the best interests of those who live there, with practices that promote and safeguard the welfare of everyone at the home. However, people’s health and safety would be better protected if additional action were taken on one matter. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Mike Sharland, the manager of the home has a recognised care management qualification (Registered Managers Award). He confirmed that, in the last year, he has had recommended health and safety updates, some managementrelated training, and an annual appraisal. Churchill House DS0000071054.V366421.R01.S.doc Version 5.2 Page 25 There were no residents’ meetings, but the manager said he met everyone on a one-to-one basis to get their views, and to give them an opportunity to ask or tell him about anything. People living at the home confirmed this was the case. Both they and the staff said he was always available, approachable and supportive. A relative reflected this – ‘We always find the manager very approachable and kind.’ A staff member commented, ‘My manager not only cares for our service users, he also takes time out to make sure staff are happy.’ One person living at the home recalled completing a survey on the care, etc. for the home. Staff confirmed there were unannounced monthly visits by the provider’s representative to check various aspects of home life. The manager showed us a corporate monthly self-assessment form for home managers to complete. This included listing activities/events that have taken place at the home, and that a social care code of conduct was available. No-one on the home’s staff acts as appointee for anyone living at the home, leaving people free to choose who helped them to manage their money. We looked at records of personal spending money for two people, held by the home. Two signatures were obtained to verify the transactions shown, and receipts were available when we requested them; cash held tallied with the total shown on the records. We saw care plans were kept on a shelf in part of the lounge-diner used by staff, where they could easily access them. The manager agreed to put them in a lockable storage facility, to ensure peoples’ personal information was kept more securely. We saw records showing staff had had fire safety training in May 2008, from an external trainer. The manager said he gave 3-monthly updates at other times. Individuals’ risk assessments in their care plans included support they might need in the event of fire. We discussed cleaning of the laundry room, to prevent accumulation of fluff, which could be a fire risk. The manager confirmed there was always a first aider on duty. We noted that care records for one person we case-tracked included that they had fallen, but could not find a related accident form; we saw such forms had been completed to properly record other accidents. The manager said he would follow this up. One person living at the home told us that their electrical items had been tested for safety by the home. They also told us the mains and storage water systems were tested monthly, adding they felt things were well attended to. Maintenance records showed that window restrictors, showerheads, wheelchairs, etc. had monthly in-house checks and were then maintained as necessary. Staff confirmed kitchen equipment, hoists, etc. were serviced regularly, as we noted from the AQAA and from labels on individual items. Churchill House DS0000071054.V366421.R01.S.doc Version 5.2 Page 26 We found two first floor bedrooms windows could be opened wide, because the restricting device had been undone. The manager agreed to address this problem urgently. The cook was aware of the latest food safety guidance and described how it was being put into practice. Food portions in kitchen fridges were covered and dated. Churchill House DS0000071054.V366421.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Churchill House DS0000071054.V366421.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? N/A 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 OP9 Regulation 13(2) Requirement You must ensure that there are proper policies & procedures for the recording, storage and disposal of medicines received into the care home, and that staff adhere to them, especially Ensuring secure storage of controlled drugs that meets current legislation; Recording of medication given to people who then self-medicate, to provide a clear audit trail of their medication; Storing all medication in the appropriately-labelled packaging it is received in; Establishing a system for checking medication is ‘within date’ for safe use; - To ensure medication is safe and kept securely, promoting peoples’ welfare. You must ensure that (a) All parts of the home to which people have access are so DS0000071054.V366421.R01.S.doc Timescale for action 16/07/08 2 OP38 13(4) (a) & (c) 16/07/08 Churchill House Version 5.2 Page 29 far as reasonably practicable free from hazards to their safety; and (c) Unnecessary risks to their health or safety are identified and so far as possible eliminated – To manage any risks to people at the home from falling from a height. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP18 OP29 Good Practice Recommendations You should ensure that the home’s written safeguarding policies are robust, up to date and in line with the local authority’s agreed safeguarding protocols. You should ensure you obtain a satisfactory written explanation of any gaps in the employment history of prospective staff. Churchill House DS0000071054.V366421.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Churchill House DS0000071054.V366421.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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