Inspection on 18/06/07 for Cleeve Court

This inspection was carried out on 18th June 2007.

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

The inspector 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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Cleeve Court Bath Community Resource Centre Cleeve Green Twerton Bath BA2 1RS Lead Inspector Carole White Unannounced Inspection 09:30 18 – 20th June 2007 th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Cleeve Court DS0000069975.V343036.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. Cleeve Court DS0000069975.V343036.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cleeve Court Address Bath Community Resource Centre Cleeve Green Twerton Bath BA2 1RS TBC 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) Bath & N E Somerset Social Services Mrs Sheila Rose Wright Care Home 46 Category(ies) of Dementia (25), Old age, not falling within any registration, with number other category (21) of places Cleeve Court DS0000069975.V343036.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 categories: Old age, not falling within any other category Code OP - maximum number of places 21 Dementia, excluding learning disability or mental disorder - Code DE - maximum number of places 25 The maximum number of service users who can be accommodated is 46. Within the overall maximum number of service users permitted to be accommodated in the home, the registered person may at any one time accommodate up to 5 service users who have been assessed as meeting the eligibility criteria to receive the services of the inreach nursing team supplied by Bath & North East Somerset Primary Care Trust. New service 2. 3. Date of last inspection Brief Description of the Service: Cleeve Court is a Bath & North East Somerset Council Care Home for older people and people with dementia. The home is situated in part of a new purpose built Community Resource Centre based in the Twerton area of Bath. The Bath Community Resource Centre is the first to be completed of the three centres that will cover the whole of the Bath & North East Somerset area. The centre also includes the Carrswood and Hazelmeir day centres; the assessment and re-enablement home care service, supported living services, a range of meeting & activity rooms and therapeutic facilities that can be assessed by the local community. The main kitchen is situated on the ground floor and provides meals for the care home and the two day centres. The care home occupies the first and second floors of the building. Cleeve Court replaces existing registered care homes operated by the council and all of the current residents have moved from two council care homes, Marjorie Whimster and Green Park in Bath. The first floor (Kelston Rise) is for people with dementia and the second floor (Lansdown View) is for older people. Both floors are assessed by a lift and each floor has a separate lounge, a lounge/dining room, a kitchen and other seating areas. Every room has ensuite facilities with walk-in showers and some have ceiling hoists. Each floor also has separate toilets and assisted bathrooms. The centre has landscaped gardens and parking for visitors and staff. Cleeve Court DS0000069975.V343036.R01.S.doc Version 5.2 Page 5 The main telephone number for the building is 01225 396787, Lansdown Rise (2nd Floor) 01225 396793, Kelston View (1st Floor) 01225 396795. The manager named on page 4 of this report is absent from duty and the name of the acting manager is yet to be confirmed. Cleeve Court DS0000069975.V343036.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced site visit that took place over two and a half days as part of the key inspection. On the first day two inspectors were present, one inspector spend the day with the residents and staff on the dementia floor and the other inspector spend the day with residents and staff on the older people’s floor. The second day was spent looking at records. On the day of the site visit the home had twenty-eight residents, twenty-one on the floor for older people and seven on the floor for people with dementia. Survey forms were sent to the home prior to the visit and given to residents. 18 survey forms were returned. Ten residents were interviewed, six of them had requested on their survey form to speak to an inspector, and several others were spoken with informally. All members of staff on duty during the site visit were spoken with and the Community Resource Manager and the senior support workers assisted with the site visit. What the service does well: The home provides a good standard of accommodation in a new purpose built complex with pleasant and well decorated rooms, all with en-suite facilities. The home is clean and well-maintained. Overall, residents are happy with the new building and the facilities on offer. There is clearly the potential, with the facilities available within the whole community resource centre, to offer residents a variety of activities and a lifestyle of their choosing. Some residents, especially those who go out to the local shops and into the gardens, enjoy living in the home and have a lifestyle that meets their expectations. There is an experienced and long serving staff team that know the residents well and have been able to maintain the continuity of care throughout the changes that have occurred with the move into the new home. Cleeve Court DS0000069975.V343036.R01.S.doc Version 5.2 Page 7 Residents surveyed and spoken with confirmed that staff are competent to meet their personal care needs and staff treat them with respect. The home has just started a more flexible and individual way of managing residents’ medication by having all residents’ personal medication in locked cabinets in their rooms. Staff have access to a range of training and receive regular supervision. What has improved since the last inspection? What they could do better: Seven requirements were made at this visit. The registered manager is absence from duties and temporary arrangements have been made to cover the position. The commission must be notified of the timescale for appointing a new registered manager if the current manager is absent for an extended period. At the time of registration the contact telephone number of the service and the precise staffing structure of the Community Resource Centre had not been clarified. It is therefore required that the home’s Statement of Purpose is updated to explain the structure and purpose of the Community Resource Centre and how the care home fits into that structure together with a list of telephone numbers to contact the Community Resource Centre and Cleeve Court. Whilst most risk assessments are carried out when specific risks are identified not all residents had risk assessments carried out for moving and handling and there is inconsistency in the reviewing of risk assessments. The home needs to ensure that residents have access to appropriate private telephone facilities. For some residents on the second floor the overall experience of living in the home is dominated by the feeling that it is difficult to access the garden and go outside as and when they wish. It is therefore essential that the home ensures that residents, who wish to do so, have access to the gardens, either with assistance or by being encouraged to do so independently. Cleeve Court DS0000069975.V343036.R01.S.doc Version 5.2 Page 8 Some residents also feel that their choice of meals, particularly at teatime, has been reduced since moving into the home. Whist the facilities are in place the home needs to ensure that staff fully understand their role in providing food from the servery kitchens, to enable residents to have meals of their choice. Staff must receive fire training for the new building and fire drills must be regularly carried out. The following recommendations were also made at the visit: A new format for care plans and record keeping is devised that is consistent to enable staff to clearly know how to meet residents’ needs. The facilities in the main kitchen should be kept under review to ensure that they are adequate to provide suitable cooked meals for the residents when the home is fully occupied. When the remaining residents move onto the floor for people with dementia, keep the environment under regular review to ensure that these people are orientated into their new environment and the environment meets the individual needs of all the residents. Review the policy for the holding of residents’ money. Make arrangements for residents to have a wider range of activities inside and outside of the home. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Cleeve Court DS0000069975.V343036.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 Cleeve Court DS0000069975.V343036.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): 1,3 & 4 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Current and prospective residents have information about the services that the home can offer, although the Statement of Purpose does not include the telephone number of the home. Residents have had their needs assessed and they know that the home has the ability to meet their personal care needs. EVIDENCE: The home’s Statement of Purpose was examined when this service was registered in March 2007. At that time the contact telephone number of the service and the precise staffing structure of the Community Resource Centre had not been clarified. It is therefore required that the home’s Statement of Purpose is updated to explain the structure and purpose of the Community Resource Centre and how the care home fits into that structure together with a list of telephone numbers to contact the Community Resource Centre and Cleeve Court. Cleeve Court DS0000069975.V343036.R01.S.doc Version 5.2 Page 11 All of the current residents have lived in council care homes for some time and have all moved to Cleeve Court from either Green Park House in the centre of Bath and Marjorie Whimster House in Twerton, Bath. The Older persons’ floor is full at 21 residents and the dementia floor currently has 7 residents. By the end of July a further 13 residents will move from Sunnyside dementia home in Peasedown St John. All residents had an assessment of their needs carried out prior to moving into their original home. Anyone who was identified as their needs having changed were re-assessed prior to leaving their previous home. Seven residents from Marjorie Whimster House had their needs re-assessed prior to moving to Cleeve Court and as a result of the new assessment were admitted to the dementia floor. Most of the staff working in the home have moved from the previous homes with the residents and therefore know and understand the residents’ needs. Residents surveyed and spoken with confirmed that staff are competent to meet their personal care needs. Cleeve Court DS0000069975.V343036.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 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Residents’ health & personal care needs are being met and recorded in a care plan, although documentation used is inconsistent and risk assessments are not carried out for all identified risks. The home protects residents by reviewing their health needs and appropriate drug administration. EVIDENCE: The care plans for eight residents were examined, six from the second floor and two from the first floor. Overall care plans give details of peoples’ health, personal and social care needs and these are being kept under monthly review. However, all files examined still had the documentation from the previous two homes and the presentation of the care plans differed. The care plans follow through separate headings giving information about the person’s needs under each heading and therefore are lengthy and time consuming to read. In one of the formats seen these headings were recorded on separate pages making the care plan twenty-one pages long. Cleeve Court DS0000069975.V343036.R01.S.doc Version 5.2 Page 13 Also, whilst the care plans give details of the person’s needs they could give more details about the actions that staff need to take to ensure that residents’ needs are met. In particular it was difficult to track how often it had been agreed that a resident would want a bath and when this took place. Key workers appeared to have an overview of the agreed bathing arrangements for the residents allocated to them but the care plans did not specifically identify a day or frequency. Notes are not always completed daily and therefore it is difficult for staff, other than the key workers, to know whether or not a resident is due for a bath or when they last had one. As previously mentioned because staff have moved with the residents from their previous homes they are familiar with the residents’ needs. However, new staff commented that the care plans are not always easy to follow and because notes about residents are not regularly completed this makes it difficult to have up to date information about the person. Daily notes are completed in a ‘handover’ book that the senior care workers use, although it was not clear how well this information is communicated to the rest of the staff. The files for two residents had been updated with a new care plan format and these gave comprehensive and clear information for staff to follow. Whether or not the home decides to use this format all care plans should be changed to one single format to achieve a consistent presentation of information for staff to follow. Two files viewed had incomplete ‘pen portraits’ and one resident with diabetes was overdue for her blood sugar monitoring. Files show risk assessments for most of the identified risks, although not all showed evidence of review. Again there were differences in the documentation between the files from the two different homes. In three of the files examined the mobility and handling profiles identified that the person required assistance with bathing or transferring, but there was no evidence of a separate risk assessment detailing the specific risks involved and actions as to how staff should carry out the tasks. It is therefore required that separate risk assessments are carried out for moving and handling when the need is identified and that all risks assessed are reviewed in conjunction with the care plans. All residents spoken with and surveyed confirmed that staff treat them with respect and understand their needs. Comments from residents included: “The staff are very kind”, “Staff are very good”, “I get on well with the staff and my key worker is super” and “I get very nervous about undressing but the staff are very kind to me”. Cleeve Court DS0000069975.V343036.R01.S.doc Version 5.2 Page 14 Medication is administered through a monitored dosage system arranged with a local pharmacy, and at the time of the inspection senior care workers were administering the medication to the residents. Immediately prior to the inspection the home had installed lockable cabinets in residents rooms to hold their individual medication. The aim is for support workers to administer medication as part of delivering the care to each resident, which should make the timing of assisting with medication more individual and flexible. Arrangements are being made for staff to attend NVQ accredited training in managing medication through the local pharmacy. Residents spoken with were happy with the new arrangements for the management of the medication. Cleeve Court DS0000069975.V343036.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 adequate. This judgement has been made using available evidence including a visit to this service. The home enables the residents to maintain contact with families and friends, although this would be enhanced by better access to telephone facilities. Activities within the home are provided and residents are mostly able to have meals of their choice. EVIDENCE: Weekly activities are arranged for residents, these include quizzes, hand massage, bingo, reminiscing and exercise. Whilst residents spoken with and surveyed were happy with the activities on offer given the facilities available within the Community Resource Centre, separate activities room and a day centre on site, it should be possible for the home to provide a wider range of activities. Some residents like to be taken out to the local market once a week and although this is arranged those spoken with confirmed that it was not possible to go as often as they would have liked. It is recommended that the home makes arrangements for residents to have a wider choice of activities inside and outside of the home. Cleeve Court DS0000069975.V343036.R01.S.doc Version 5.2 Page 16 Telephone points are available in each room for residents that wish to have they own private line installed, although none have arranged for this to be done, and a payphone is available on the ground floor. There is no facility for residents to take in-coming calls in private and the payphone downstairs would be difficult to access with a wheelchair. On the day of the visit one resident was seen speaking to her daughter in the staff office. It is required that the home makes suitable arrangements for residents to have access to private telephone facilities. This was discussed during the feedback at the end of the site visit and calls were made to see if a system could be set up whereby residents can have a telephone in their rooms to receive calls and some system to pay for external calls. One resident had asked prior to moving into the home (he moved in March 2007) that he have the facility to watch satellite television and this had not been arranged for him. This was also discussed during the feedback and the Resource Centre Manager thought that this had been arranged and put plans in place to organise this for the resident. Meals are cooked on the ground floor in the kitchen that provides for the care home and the two day centres. Meals are then brought up to each floor and served from a smaller kitchen in each dining room called a ‘servery’ kitchen. The smaller kitchens have facilities to prepare and cook light meals and hot drinks. A choice of menu is available and residents choose the day before which meal they would like. The cook and kitchen staff confirmed that they are able to accommodate any special dietary requirements. Residents spoken with and surveyed all confirmed that they enjoyed the meals. Two residents commented, “The food is beautiful” and “Much better than other home”. However, one resident was upset because she had not been able to have cheese on toast for her tea since moving into the home. On further discussion it appeared that she had been informed that it was not possible for the home to provide cheese on toast, even though it is shown on the menu some days, because the kitchen closes at 3pm and the support workers do not have the facilities to prepare it. Another incident was also reported at the visit whereby some residents have been left short of sandwiches at teatime because there had not been enough to go round. Staff were clearly upset by this but felt that resolving the situation was out of their control as the kitchen was closed at teatime. It was clear from speaking to the Community Resource Centre Manager and observing the facilities available in the servery kitchens that is completely possible for staff to provide any light meals that residents may require to supplement the food prepared by the main kitchen. Cleeve Court DS0000069975.V343036.R01.S.doc Version 5.2 Page 17 The cooker in the servery kitchens can also be used as a grill to prepare light meals such as cheese on toast and a list was seen on the wall supplied by the kitchen for staff to order any supplies from the main kitchen to make light meals and sandwiches. Providing that the appropriate risks were assessed there would be no reason why some residents could not be encouraged to use the servery kitchen facilities themselves. Staff spoken with were very negative about the servery kitchens and the role that they could play in working with the main kitchen to provide meals of residents’ choice. It is therefore required that the home ensures that staff fully understand their role in providing light meals and snacks from the servery kitchens. Cleeve Court DS0000069975.V343036.R01.S.doc Version 5.2 Page 18 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. This judgement has been made using available evidence including a visit to this service. Residents are enabled to complain and are confident that their complaint will be listened to. Practices at the Home ensure protection of residents from harm and abuse. EVIDENCE: Appropriate procedures are in place for the management of any complaints. The home has only received one complaint since it opened in March 2007 and the commission has not received any. All staff attend training in the Protection of Vulnerable Adults from Abuse as part of their initial induction. Refresher training for current staff is not completely up to date and this should be remedied by training that has been booked. Staff spoken with demonstrated that they had a good understanding of how to identify potential abuse and report it. Cleeve Court DS0000069975.V343036.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 adequate. This judgement has been made using available evidence including a visit to this service. Residents live in a safe, clean and well-maintained environment with comfortable bedrooms, that they are able to personalise with their own furniture and possessions. Access to outdoor facilities is not being facilitated for some residents and the environment may not be suitable for people with dementia. EVIDENCE: The home is situated within the Bath Community Resource Centre and occupies the first and second floor of the building. Both floors are assessed by a lift and each floor has a separate lounge, a lounge/dining room, a ‘servery’ kitchen and seating areas at the end of each corridor. Every room has en-suite facilities with walk-in showers and some have ceiling hoists. Each floor also has separate toilets and assisted bathrooms. Cleeve Court DS0000069975.V343036.R01.S.doc Version 5.2 Page 20 The main kitchen is on the ground floor and provides meals for the care home and the two day centres. The kitchen has one oven and one steamer for cooking vegetables. At the moment the home is not at full occupancy but when it is there is the potential that the kitchen may need to provide meals for up to 90 people per day. It is therefore recommended that the facilities in the kitchen are reviewed when the home is full to ensure that there are adequate cooking facilities to provide for the required numbers. The first floor has direct access to a secure garden and this garden as well as a lower garden on the other side of the building can be accessed via the lift from the second floor. The home has recently employed a full-time maintenance person who currently just works at this resource centre but will cover all three centres when the other two are opened. On the two days of the site visit the home was clean, hygienic and free from unpleasant odours. The communal areas seemed slightly too warm and staff also commented on this. On the day of the feedback staff reported that they had spoken to the maintenance man and were shown how to control the temperature. Residents did not make any comments in relation to the temperature of their rooms and individual thermostats were seen in each room which staff would now know how to alter if asked to do so. Staff and residents also made very positive comments about the facilities in the assisted bathrooms and in particular the way in which the height of the baths can be altered to adapt to individual residents. All residents surveyed and spoken with confirmed that they like their rooms and the en-suite facilities. Comments made by residents about their rooms include: “My room is very nice”, “100 better, more room and more comfortable than the other home” and “I like my room”. However, for some residents on the second floor the overall experience of living in the home is dominated by the feeling that it is difficult to access the garden and go outside as and when they wish. Comments made by residents with regard to the garden include: “We would like to have a garden so that we could walk around as I feel trapped”, “The home feels like a prison”, “ I feel the roof is on my head like a prison and I cannot go out as I would like” and “I would like to sit out in the fresh air”. It was evidenced that both residents and staff feel anxious about using a garden that is not directly accessed from the living area of the home and this is perceived as being difficult and disempowering for people. Some residents spoken with said that they are not allowed to use the lift on their own and therefore have to reply on staff to take them down to the garden. Cleeve Court DS0000069975.V343036.R01.S.doc Version 5.2 Page 21 However, some residents do go downstairs to the garden and two residents go out daily to the shops. Those residents who do go out to the shops and into the garden regularly are very happy in the home and are experiencing a far better quality of life. It was clear from speaking to the Community Resource Centre Manager that the aim of the home is for residents to be empowered to use all areas of the centre. However, a culture appears to have developed in the home with some staff of feeling negative about the second floor not having direct access to the garden and that negativity may have transferred to some residents. It is essential that the home ensure that residents who wish to do so have access to the gardens, either with assistance or by being encouraged to do so independently. Staff and some residents also made comments that both lounges have televisions in and there is no ‘quiet’ lounge. There is a reasonably private seating area at the end of each of the two corridors on each floor. These areas have a built in long seat and windows across the whole wall, and on the floor for people with dementia, access to the garden. The walls have been painted with pictures to identify each area and these are seen from the centre of each floor. However, these areas were not used at any time during the visit and on the dementia floor the area was being used to store equipment. The seats may not be comfortable for all residents and the areas did not have anything of particular interest such as books or magazines to draw people to sit there. It was not possible to judge whether people did not like sitting in these areas or if they were not really aware that these areas could be used. At the time of this visit the floor for people with dementia only had seven residents and these people have not moved from a designated dementia home but had been recently re-assessed as having dementia. By the end of September a further thirteen residents will have moved from Sunnyside, the council’s home for people with dementia. Prior to the home opening the council commissioned an expert to assess the environment on the first floor for its suitability for people with dementia. As a result of this report the two seating areas at the end of each of the two corridors have been painted with different pictures to help to orientate residents. The report also advised that it is helpful if toilet and bathroom doors and painted in a different colour or marked with a symbol so that residents can clearly identify them, although the report concluded that what people will recognise can be very individual. Residents have individual pictures of their choice on their doors to help them find their rooms. Cleeve Court DS0000069975.V343036.R01.S.doc Version 5.2 Page 22 Staff on the floor for people with dementia did report that the residents were having difficulty finding the toilets as the home that they had all come from used a different name for the toilet than was now being used. During the site visit one of the inspectors walked with a resident around the home and she was not able to recognise the door of her room, although she did recognise the room when she looked in through the door. Until the new residents move in is difficult to judge if the environment is be suitable to meet the needs of people with dementia. It is recommended that when the remaining residents move onto this floor, the home keeps the environment under regular review to ensure that these people are orientated into their new environment and the environment meets the individual needs of all the residents. The floor for people with dementia and how the residents have settled into a new environment will be the focus of a further visit to the home later this year. Cleeve Court DS0000069975.V343036.R01.S.doc Version 5.2 Page 23 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. This judgement has been made using available evidence including a visit to this service. The home’s recruitment practices and numbers of staff working protect residents. The home ensures that staff are trained and competent to carry out their work in order to meet residents’ personal care needs. EVIDENCE: A sample of staff files were examined, although the original recruitment records are held centrally. All files examined had the relevant documentation. Evidence from viewing the rotas and spending time in the home shows that people’s needs are met by the staffing levels. Each floor has a senior support worker on each shift. Staff work between the two floors and during the course of a week will cover shifts on each floor. Training records showed a good standard of training available to staff. In speaking with staff they confirmed that there are good opportunities for training. All staff have attended dementia awareness training. Cleeve Court DS0000069975.V343036.R01.S.doc Version 5.2 Page 24 Mandatory training in manual handling, first aid and vulnerable adults is mostly up to date and this will be remedied when booked training takes place. Existing staff have not received fire safety training for this building. This is discussed in more detail in the management & administration section of the report. Staff are also in the process of undergoing in-reach nursing training as this home has been registered to provide services for up to 5 residents under the in-reach nursing team supplied by Bath & North East Somerset Primary Care Trust. The home has an on-going programme for NVQ and 10 staff have either completed or are working towards their NVQ level 2 and 7 staff have either completed or are working towards NVQ level 3. Cleeve Court DS0000069975.V343036.R01.S.doc Version 5.2 Page 25 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, 35, 36, 37 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some residents and staff feel negative about living and working in the home, this will hopefully improve when the management arrangements have been resolved. The practices of the home help to make sure that the health, safety and welfare of residents and staff is protected, although fire safety training and fire drills have not been carried out for all staff. EVIDENCE: Immediately prior to the site visit the commission was informed that the registered manager was absent from duty and a manager from another service has been moved to cover the post. Cleeve Court DS0000069975.V343036.R01.S.doc Version 5.2 Page 26 It is noted that the provider acted swiftly and responsibly to protect residents and the safe running of the service as soon as the manager’s absence commenced. However, the provider must notify CSCI of the timescale for appointing a new registered manager if the current manager is absent for an extended period. It is clear that opening a new home, and moving residents who may have lived for years in their previous home, would require a manager who could inspire and motivate people to feel excited about a new project. It is possible that problems around the culture and attitudes of the staff may well be attributed to difficulties with the management of the home. However, it is clearly evidenced that staff have been committed to residents’ well-being and safety. The senior support workers in particular have worked hard to maintain the rotas and ensure that residents’ needs are meet. Evidence from staff records showed that staff have received regular supervision. Staff spoken with confirmed that they have received supervision and their training and development needs are discussed at these meetings. There was evidence of risk assessments on various areas of the home. A fire risk assessment has been carried out for the whole building and monthly fire equipment checks are taking place. However, the home has only just obtained detailed information with a plan of the building and the different fire zones to be able to arrange fire safety training and carry out a fire drill. It is clear that the home has done all it can to inform staff of fire safety procedures and information about temporary procedures were seen on both floors in the staff offices. Staff spoken with said that they had been given basic information about fire safety for this building. New staff that have just completed their induction have received fire training. However, it is essential that the home ensures that all existing staff receive fire training and fire drills are regularly carried out. The home has a system of keeping residents’ weekly allowances and records seen showed that sound systems are in place for recording this. However, it was also evidenced that not all resident’s regularly asked for access to their money and therefore this policy of routinely holding money seemed unnecessary and it may be a safer practice to arrange for people to have direct access to their money from a bank account. Cleeve Court DS0000069975.V343036.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 2 X 3 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 2 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 2 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 X X 2 3 3 2 Cleeve Court DS0000069975.V343036.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 OP1 Regulation 4(1)(c) Sch 1.1 & 4 Timescale for action Update the Statement of Purpose 31/10/07 to give details of the registered manager, the staffing structure of the Community Resource Centre & Care Home and relevant telephone numbers. Complete risk assessments for 30/09/07 all residents where the need for assistance with moving and handling is identified and keep under regular review. Ensure that residents have 31/10/07 access to appropriate private telephone facilities. Ensure that staff fully 31/08/07 understand their role in providing food from the servery kitchens, to enable residents to have meals of their choice. Ensure that residents who wish 31/08/07 to do so have access to the gardens, either with assistance or by being encouraged to do so independently. Notify CSCI of the permanent 31/08/07 arrangements for the management of the home. Requirement 2 OP7 13(5) 3 4 OP13 OP15 16(2)(a) (i) & (b) 16(2)(i) 5 OP20 23(2)(o) 6 OP31 38(2)(a) Cleeve Court DS0000069975.V343036.R01.S.doc Version 5.2 Page 29 7 OP38 23(4)(d) (e) Ensure that all staff receive fire training and fire drills are regularly carried out. 30/09/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard OP7 OP12 OP19 OP19 Good Practice Recommendations Devise a format for care plans and record keeping that is consistent to enable staff to clearly know how to meet residents’ needs. Make arrangements for residents to have a wider range of activities inside and outside of the home. Review the facilities in the kitchen to ensure that they are adequate to meet the needs of the residents when the home is fully occupied. When the remaining residents move onto the floor for people with dementia, keep the environment under regular review to ensure that these people are orientated into their new environment and the environment meets the individual needs of all the residents. Review the policy for the holding of residents’ money. 5 OP35 Cleeve Court DS0000069975.V343036.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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